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Home My WebLink About518-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTiFiCATE OF OCCLIPAIqCY No ......... ~f....5. ?~L.! .... Date ............................... .6'..g.~?.... ].]. .......... , 19...5...0.. TI-IlS CERTIFIES that the building located at ..~./.~..[~[~.J,.~..:~¢~..i-..(,xL~j...~.~.. Street Map No ......................... Block No ......................... Lot No ................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... ~.o..~..c;~¥.~]9..q~'...~..3. .......... , '19..~..~.., pursu,ant to which Building Permit No ......... ~...5.[.8. ...... dated ......... ..~..°..~.~.~.~.'.z~...~.3. .................. ]9...5..~..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................ .......................................... .P~.$..v.~,'~,...9. ~.~.~;...~v~;;~y...~×~ ~;~c~ ....................................................... This certificate is issued to ....~:'.~.;~)..~.¢,.!~..,~;r~'f.~.~..~...,.o..~?.~.~k¥. .............................................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM 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.° 518 z Dote ............. ~¥.~.~.~ r..... ,~ ................ 1~.~ ..... Permission is hereby granted to: A~......~. ~.~.~.~P,. .............................................. .... 3~.-....3.1~.....~1.. ~.t~.....,T. Imlme~ ..~t~ ... at premises located ot ....,/~ ......:X~,D..~I~ ....................................................................................... .................................................... ~.T..~ .,'.,'~ .~.~.......~L,.~., .............................................................................. pursuant to application dated .............]IO~.~DD.~e~......~ ...................... 19.~.., and approved by the Building Inspector Fee $ ~.;.?-..0.. .............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDr, N. Y. ~xa~ined .............................. ~ ............. L~ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .......... ~LL~il..~. ~ iljS~..~:.~_:~Zr ...... (Building Inspector) Application No. ~ / ~ APPLICATION FOR BUILDING PERMIT - ,ate ............... ....... .......... INSTRUCTIONS o. 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 drown 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 port 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 issuanc,e 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 oil applicable laws, ordinances and regulations. Lr c c4 .... ...4. .......... .................. ................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ame at owner at premises...(:;/-7--T~.. .................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposttd work will be done. Mop No: ............................................ Lot No: .................... Street and Number ..?..~...~........~..~.....~,.~:~..-.~.. ....... :~'.....~~'""~'~':' ......................... Municipality 2. State existing use and occupancy of p~emJses and intended use and occupancy of proposed construction: a. £xisting use and occupancy ....................................... ) ...................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Iteration Repair .............. w...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, Jf any: Front ............................ Rear ............................ Depth ............................ 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 ........ .~....~... ....... Rear ............................ Depth ............................ Height ............................ Number of Stories ...... ~ ........... l s ~. Size o~ lot: Front ............................ Reef ............................ Depth .~... ....................... 1]. Zono or uso district in which premisos oro situoted ............ ~ ........ ~.~; ............................................................... 12. Does proposed construction vio[o~ ongjonin0 Iow, ordinonce or re0ulofion? ............. ~ ............................... 13. ~ome of Owner o{ premises..~.¢{.....~~.Address~ ~ ............................................ ~hone ~O Name of Architect ................... t .................................... Addross ............................................ Phone NO ..................... Nome 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 NEV~YO~,R~J~, ............................ (Z...-~..ff.......~..~..;~.....being duly sworn, deposes and soys that he is the applicant (Name of indi¢~ual signing application) above named. He is the...........,f .................... ~ ~ ........ ~ ........................................................................................ (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 m.anne~ set ~[~ .i9 the application filed therewith. Sworn to before me th s ............ A~.... da~ of ..../~..~.~] ............~.~t,~..pz ~,~.,,,., /~ , (~gnature/~f ~licant) FORM NO. 1 TOWN OF SOUTHOLD BUILDIbtG DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... (Building Inspector) Application No. ~ / '~'' APPLICATION FOR BUILDING PERMIT Date ................ ~. }Z..).{..~.. .......... ~,..Z% ........... 19..?..~ .... 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 end of buildings on premises, relotionship 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 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 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 a Iterations, 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 wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ l ? // 'n /'7 .............. L; ............................................................................................................... Name of owner of premises...~.~..T..)~.',,~..~:%¢r.~. ...... .?.~.'-../.::'.:%~.~':.~."%L~'?r'?'"'~':'""~' ' ....................................................................... If applicant is a corporate, signatu/e of duly authorized officer. (Name and title of corporate officer) 1. Location of land on w,h,,ic/h propo~,~, work will be d,.one. Mop .No: ............................................ Lot No: .................... Street and Number ,7.~.~.' ~.. ~//,¢,~,;~,~ (.~ r, ,..d .,, {~,,~....~.. ........... /~.../r..,~..x. ~;(/. Municipality 9. State existing use end occupancy of p~emises and intended use and occupancy of proposed construction: o. Existing use end occupancy ..................... ~.~..~.'.~.= ...... t' ...................................................................... b. Intended use end occupancy ................................................................................................................................ 3. Nature of work (check which applica'ble): New Building .................... Addition .......... ~Alteratlon ....~ ....... Repair .................... Removal_ .................... Demo[itlon .................... Other Work (Describe) .................... 4. Estimated Cost......). ...................................................... Fee ..,.~' ....... ~ ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... .qZ~..~.....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 ............................ 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 ........ ~......~.. ........ Rear ............................ Depth ............................ Height ............................ Number of Stories ...... .~.,~,,r ............ 9. Size of lot: Front / ~-/"T Rear /~'~ '~ Depth 10. Date of Purchase ........... ../. .... Name of Former Owner ..~.[:. ............ ?.~..%..~.~ ........ 11. Zone or use district in which premises are situated ........... ~...: ....... .~J~':?LR ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises...~(~.t/~.~....".~.~ ........ Address ............................................ Phone NO // Name of Architect .................... f .................................. Address ............................................ Phone NO ..................... · ?..~..~..h,~ ...... .x:..~..~ ............ Phone NO ..................... Name of Contractor....~..~...~,..<.'.;~,~,,.~,~.&~...Address PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram 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 NL~.Y4D~'~r/~- ) S S COUNTY OF u'/__/"//'f; ......................... Y....'....../.x~.,~.?/.'.u.~.:.r....../..,:~..;~,..c.::.~;>m:.n:~..-~.~...being duly sworn, deposes .and says that he is the applicant (Nome of in~ivi~t'al4r;f,~ signing applica?on) above named. He is the .................................. ~c'~.:' .......... ;?:~'~?."'; .......................................................................................... (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 wark will be performed in the manner set forth in the application flied therewith. Sworn to before me th s ~,~, ~ ~ . Notary Publ,c,'..fL~2~;z~'..·..~~....~....~-~..~8'Lirf~';~'~ ,'~/~, . /.C:~:'~ ¢.~ ,/]'l/ ~/~'~/2),(~_ ~,,