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Home My WebLink About495-z~01~ ~TO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~/..~...~.~.~.~.~....~.p...~..~..,....~...~..~...e.~J~..~.~. ...... Street Map No ............ .~.~..~., ..... Block No. '~e Lot No. ~/~ conforms substantially to the Application for Building Permit heretofore filed in this office doted Oet. obe~' 23. .5...8. ........................................................ , 19.. ., pursuant to which Building Permit Na. ~. 495 dated October' 2Li 19..,~..8..., wa,s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ ........................... ..................................................................... This certificate is issued ta ...,..r~...Ol~i...~.....~.?..~.~.....O....~..,~...~. ................................................................... (owne.r, lessee or tenant) of the aforesaid building. FOI~M NO. 2 TOW~q OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, 1'4. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 495' Z Dote OC ¢O~ 21 19 t~ Permission is hereby granted to: ............. ~o~.~.~...~ ................................................... at premises located at ...~.....[~D.~¢~ Ro~d . ......................... ~.~t~?~ 21 ~9 ~, ~d ~pproved b~ the pursuant to appJicalion dated .................................. ' ..... Buiidin9 Inspector Fee $,.... ~'.~.0.0. ......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ............... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ...,<.:....~ ............................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................................... 19 .... INSTRUCTIONS a. This application must be complet~ely 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 are~s~ and giving o detailed description of layout of property must be drawn on the diagram which is pert of this location. c. The work coYered by this application may not be com~e~nced before issuance of Building Permit~ d~ Upon ~pprov~l of this ~pplic~tion, t~e Building Inspector ~ill issue ~ ~uilding Per,it to the ~pplic~n~. Such permit shall be ~ept on the premises ~wil~ble ~or inspection throughout the progress o~ the work. e. ~o building sh~ll be occupied or used in whole or in part ~or ~ny purpose ~h~tever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and ,?gulations. (Signeture o¢ epplicent, or nome, i~ ~ corporetion) ....... . .................. (Address o¢~pplicont) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of remises . :.. ,. ~......i./.6.....~...?v... p .......... -.-. ...... --- . ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work willbe done. Map No: ............................................ Lot No: .................... Street andNumber ...~...~ ~...~;/L,~ ::~ ~ ' ' Municipality 2. State existing use and occupancy of p~i?es and intended use and occupancy of proposed construction: a Existing use and occupancy ~~'~' ~ b. Intended use and occupancy .........................I. ................ ~...~: ....... ~ ............................................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ~............Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... o-/2 ............................................................................ 4. Estimated ~. sr.z ........................................................... 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 ........ ~_,~.. ......... Rear ......... ...~.....?. ......... Depth .....~....O.. ................. Height ............................ Number of Stories ........ ~ .................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ Z...~.. .......... Rear ......... ~...~( ............ Depth ....?....~?.. ................. Height ............................ Number of Stories ....... ~ ....... 9. Size of lot: Front ~ '%'- ~ Rear Depth ,-~ ~70 ~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................. ~1'....~..'. ........................................................ 12. Does proposed construction vi,ola_.l.l.~ any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises...~....../..~.....Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... 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 NElLie' Y~(~K.//(..~ ) S $ COUNTY OF ~...'Z-.~...) ' ........................ ~~.......'..~../.~.~...~ ..................being duly sworn, deposes and says that he is the applicant (Name-- ' 'of ir~dividual 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 application are true to the best of his knowledge and belief; and that the work will be performed in the manner, set for~h in the appl?,x~iion filed tth~ewith. Sworn to before me this .. - ~ Z-'--~ .... s,,-~"~_~~~ ~ZI~ Notary u ' FO~M NO. 1 TOWN OF $OUTHOLD TOWN O ,CE $OUTHOLD~ N. Y. Examined ............................................... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .............................................................................................. (Building Inspector) Application No. ,~_~_Z~_~ ....... APPLICATION FOR BUILDING PERMIT Date ................. ......: .................................... 19...~ ........ INSTRUCTIONS o. This application must be complel~ely filled in by typewriter or in ink and su~omitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odioining premises or public streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is port of this location. c. The work covered bv this opplicotlon may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Builcl'ing 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 ail applicable laws, ordinances and~.regulations. ............. ~ '.~ ?.,'. k~2~:'.;~:.~.....f.:?.::...'...~Z~f: .................................... (Signature of applicant, or name, if a corporation) (Address of dpplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameur-' owner u.~ ' '"" '~'"'~ ~ ' .... ' If applicant is a corporate, signature of duly authorized officer. 1. Location of land on whic~h~propos~ed work will,be done; Map ~No: .................. ~ ......................... Lot No: .................... Street and Number ................................... :'r;.'.-.:~:':'Z':':'~'~''~:'~' ....................... t .......... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................. ~:-. ................................................................................ b. Intended use ond occuponcy ........................................ ~....~.~c;.;~...~..,: .......................................................... 3. Nature of work (check which appllcable): New Building .................... Addition ...... ..~Z...........Alterat~on .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.../...~...~..'Tff...~.. ........................................... 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 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. o. 7. Dimensions of existing structures, if any: Front ........ ......... Rear ......... ......... Depth ...~.~...¢.'.). ................. Height ............................ Number of Stories ........ .~'~ .................................................................................... Dimensions of same structure with alterations or addJtibns: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... /.....z:7~ ........... Rear ......... ~..~.~'. ........... Depth ......... ~ .................. Height ............................ Number of Stories ....... :.: .................. 9. Size of lot: Front ..... ..~.':...~Z..~ ....... Rear ............................ Depth ,~,2 /?~'~ '- 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ere situated .................. /..:!....:'.:..~..:...: ........................................................ 12. Does proposed construction vio.~t~ any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of prem sen ........................................ Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM I.ocate 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 NEW.,YOB[~, ~ ,//, ) c c COUNTY OF ...~k.r:';',~':~'.:;.Z;;::..~.):/.,,~.~.// ~,~;,/~/? ~ /,. .............................. ~'.~'..~;.~r.... ......... ';:'"~.:'~'....".~.: ................. 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 application are true, to the bes~ of his knoMedge and belief; and t~at the wore wil be performed in the manner~t ~_r~.~ n the ~pplj6at on f ed therewith. . ~ ~ ~ , ~0~D ' , , , 'y'~/ ,~, ~ Sworn to before me th~s ~ . ~ , ',*'"',: s~t~ ,~/./Z~r'~*~ .. /, ~./~5, ) f ' .... ~ ' '~'1 -'~:~ s; ,,o~., ~o '. (S nature of a cant) ................ ~...~day o ........ .k .............................. ~'",,.~?.:t" '~,~/,;,,~ g PP Notary Pub.,c,~~..~..~ ......... County 30, ,,,~ 7