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Home My WebLink About492-zFORM NO. 4 TOWb~ OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUFANCY THIS CERTIFIES that the building located at..~/~..[~,~p..~.le.~e ................................... Streek Map No..,~c ................Block No...~lcX ............... Lot No~:~ ......... .(~ee~po~+,s.....N,Y, ..................... conforms substantially to the Application for Building Permit heretofore flied in this office dated ........................... 0e~,ober....16. ...... , 19.5~.., pursuant to which Building Permit No ........ Z..Z~g2 ........... dated ........................ ~)a.%ober....l~ ....... , 19..~1.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .............. .................. ~riv~. o~. femil~...d~lling ....................................................................................... This certificate is issued to ....~.t~,l~..]~.*....~.9.:r..~gtR ............ (.9.~..~.~..) ...................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 492, z Permission is hereby gronted to: ao~.~...~.:.....~..r~.n.. ............................................. .......... .~..8...~... ~....?~ ...................................... ................... ~..~..~..n..~...~.t..~......~.:.~... ........................ to ...~,,t~.d...~,~..~l~.~.~r~..on..~..~x,~.$.~,~...~..w.~.~o~ ...................................................... at premises located at ..... 2~.~.......~....a.~.~..~. ........................................................................................ ................................................. ~r..e..e. ~. ~.,r..$.~.....~ ,..~., .......................................................................... pursuant to application dated ...................... ...O~....~..O..~..:c;..~.....~..~. .................. 19~...~...., and approved by the Building Inspector Fee $...%.00. ............ FORI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL R.'S OMC,' SOUT.OLD. N. ','. Examined ...... ~?C.'~ · .~....../'..~ .......... 19...~ Approved ........................................ 19....[...Permit No ............................... Disapproved o/c C ......... ~' ............ ....... ......... ........ (Building Inspector) F Application No. /~7/' ~' APPLICATION FOR BUILDING PERMIT Dote ......... ~ .............................................. 1 ............ INSTRUCTIONS a. This application must be completely filled' Jn by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot end of buildings on premises, relationship to odioining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonoe of o Building Permit pursuant to the Building Zone Ordinance of the Town of Sou'thold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicroble laws, ordinances and regulations. .....z. ........ ....... ............. (Signature of opplicant, or nome, if a corporation) ..................................... : ............. ~..~1.': ............ *'~ ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) t. Location df land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and .....9~.i~ ~' Number ....... ,. "''~O~/''''''r ''~ ''~*' ~' "~ ~a~~'' .............................................................. 2. State existing use and occupancy of pr~emises,O~d intended use and occupgncy of proposed construction: b. Intended use and occupancy....~.~n,~r~x~..d~J~r,~....~..~-~..~",~.~?.~/,,~ ~' ,C,~.. ................................ 3. Nature of work (check which applicable): New Building .................... Addition .......~... .......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... / 4. Estimated Cost ............. ~.>...~...~.~ ................................. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ IF garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ........ ..c~...L.'-~..... Rear ....~.~'...,~.... . Depth Height ........ Z~....~,~......NumberO'"' of Stories ............ /. .............................................................................................. same structure with alterations or additions: Front ........ ~..~...~... ........ Rear ...... .~...~...~.. .......... Dimensions of ....."~ --.~.~..~... ........ Height ....... "~' ' J~..~..~. .......... Number of Stories ....... I ........................ / Depth 8, Dimensions of entirel) new construction: Front ......... 'm. ....... ; .......... Rear ....... .~.~..~..---- .... Depth ......./.~..~... Height ........ .~...~. ........ ,~, ,,Number of Stories ...... / .................... 9. Size of lot: Front ....... .~...0..~-.. .... Rear ........ .~. ......... Depth ....... /.../..0.....~.. 11. Zone or use district i~n which prc~ises are situated ........... ~.:....~~.;.~... ............. .W... ........................... 12. Does proposed construction vioICte~any zoning law, ordinance or regulation? ..>, ........ ~ ................ ~ .............. 13. Name of Owner of premises.~~...~.~z~Address ~.~.../~/.~ .... ,~e~.Phone NO...~....~.q..!.O..'~... Name of Architect ....................................................... Address ............................... , ........... Phone NO ..................... Name of Contractor.~....J~],~/. ...... Address ..~/~.~i..~t..Phone NO..../..~...~..?..~... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate wheth_er interior or corner lot. STATE OF NE~/-,YO~R~, ~ ~, ) S S i COUNTY OF .~.t7~..~?.....) ' ; : ............ ...................... b~ing duly sworn, deposes .and soys that he is the applicant (Name of individual signing application) I above named. He is the ................................................................ : ............................................................................................. (ContractOr, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform Or have performed the said work and to make and file this application; that all statements contained in this opplicc~tian are true to the best of his knowledge and belief; and that the work will be performed in the manne~,s~t ~,~1 iin the application filed therewith. Sworn to before me this __ -- "~'~.,~.,~hl;~'~,et~O~)£N L. ~ da.y, of ..~ ........... .~',~,~.~...~:~'~e°l~/n~.~ Yer/f /~ (Signature of applicant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×em ned ....... ...... Approved ....................... .~.../. ............ 19 ........ Permit No. ~i.~'..~... Disapproved a/c ....... ,.~ ............. ~,,,..~.. ............ 7,cr~ ............. ~ ............. :~, ..... ................................. ....... Application No. ~/~ ~' ~-'~ APPLICATION FOR BUILDING PERMIT Date ........... .................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to .adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. .............. .................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number .,~p~c~...~...~..~ ............ .~.~~., ......................................................... Municipality ~ 2. State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: a. Existing use and occupancy....Z~z.~,~¢C~ ,,~.~..~,~..~t.a.~r~,~/.,~...~_~,~ /7 ~.. /) ............. ~... ................... b, Intended use and occupancy........~..~...~...~.....~ ................. ~ ............................ 3. Nature of work (check which applicable): New Building .................... Addition .....~ .......... Alteration .................... Repair .................... I~moval .................... Demolition .................... Other Work (Describe) .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. existing structures, if any: Front ...... ~..~..~. ...... Rear .....~....~-- ...... Depth ..... ~..~......~,~-- .... 7. Dimensions of Height ....... ~..~..~ ........ Number of Stories ........... / ................................................................................................ Dimensions of same structure with alterations or additions: Front .......... ~...~..,~ ..... Rear ....... ~.b..~. ....... Depth c~ (~ 9~ Height t'~.'~ Number of Stories I-- -- new construction: Front .......... :'. ................ Rear ..... ..~...~...'~ ...... Depth ....... ,."~ / .~[..gk~ ....... 8. Dimensions of entire Height ....... ..~....~ ......... Number of Stories ......... ~. ................. Size of lot: Front .......~...~.~..(~..~....__ Rear ...~.-~..6....~. ......... Depth ......I...~..~....~...~ ~ 9. 11. Zone or use district in'~which premises are situated ................ /~Z.../.~.~..~.. ............................................ 12. Does proposed construction viola,,t~gn¥ ~zoning law, ordinance or re. gulation?~n ............. ~ ................................. 13. Name of Owner of prem.ses.....~/4~.~.. .Address ~1~. .... ~ ...... Phone NO. Name of Architect ........................................................ Address ........................................... Phone NO ..................... Name of Contractor.~v~ ....... ~r~.~....Address ....~l~....~'. ......... Phone NO.....L~...~...~..'~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWc-.YO[~K,. ]~,~ ) S S COUNTY OF ...¢~-~_~.) ' .............. ]~.:....~...~.....~.......~..,~-~zt//~'J/~ ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................................... ~ ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this a,,pplication are true to the best of his knowledge and belief; and that the work will be performed in the mann~.~t~h~in the application filed therewith. Sworn to before me this .............. .~.....~... day of ~.~...~,3~...~ ...... Notary Pub c, Z~.~--~\~~......~...?~u'nty /