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Home My WebLink About551-zFOR4~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .... ~.8......~.in..~f~ad ................................. Street Map No. ~ .............. Block No ...... ~ ......... Lot No.....~,..:~...~..,.....0.~.~.....~[,.'~.,. ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... .~e~e~ber....~l ......... , 195~...., pursu.ant to which Building Permit No ..... .~..5,51 ........... dated ................... D.e.0.emb. e.u...~.l .......... 1~¢,....., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ ................... .~ ............... ~. .......... ~.~. ...... ~....J,..~ ............................................................................................ This certificate is issued to .~.I)~,~,....,.[L~],]~...,~I~S,,..y. ............................................................ ~ .........:. (owne, r, lessee or tenant) of the aforesaid building. FO~M~ NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OJ:FICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 551, Z Date ........... ~..e..e..e...~t~.~..... 3..Z. .................. ~9.~..8... Permission is hereby granted to: ~{ez~y ~01 sa.....-~/..~.....Jli~.&.g...~... I-Ia.ll ......................... ............ O.~-i eh.t,t. .....I¢, .X., ..................................... to ....~BuLlrl..azt.. ~d~li.~±o~..oz~.. ~r~..e:~i~J: &n~...ct.~ellin6 ..................................................... at premises located at .....f~8,Ji,~..RO~.~ ........ O;F.J,~,t]~,.....~.~.%r., .......................................................... pursuant to application dated ..............])~be~......~,'], ..................... 19~...., and approved by the Building Inspector Fee $.~. $.)0 .............. [ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OF~:ICE SOUTHOLD, N. Y. Application No ..... ...~....~.i..( .......... pproved ........................................ / Y ........ ~'erm~r No ............................ Disapproved a/c ................................................................................ ...................... ........... APPLICATION FOR BUILDING PERMIT d Date ....................................... 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 Jot 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 co~ered by this application 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 o 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or o Iterations, or for removal or demolition, as berein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. ......... i~ignature c~rapplicant, or na~e, if a ~rporationi ................ ...... ?.....:...., .................... ............ (Address of applicant) ' t 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 ...~.~.. ..................................................................................................................... Municipality 2. StateexistingsUSe andc°ccupancyxistin u can ac u ,anco, of p~,emises~ and intended use and occupancy of proposed construction: a. E ' ' g d p y......~ ................................................................................................................ b. Intended use and occupancy ................................................................................................................................ ~" Alt t' . ................... 3. Nature of work (check which applicable): New Building .................... Addition .................... era ~on Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. rsti mated Cost....~....../..~..0..?~ ................................. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... (i ................... 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 ......... ~.t~. ............ 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 .......... ,~....O.. ........... Depth ../..~... ................ Height ......... .:.L2 ............ Number of Stor es ...... /.. ................... 9. Size of lot: Front ........ 2.:.~. ............. Rear ........ ~..5 ............. Depth ......./...~ ............ 10. Date of Purchase ................................ .......... Name of~For,,mer Owner .~......~...~~ ...... 11. Zone or use district in which premises are situated ................ ~ ......... ~ .................... .((. ................................ 12. Does proposed construction violate any zo~,~law, ordinance or r,e~lation? ...../..~..O., ....................... ," .......... 13. Name of Owner of premise~...~..:.~...~ ............. Address .~.....~'..~.,..~.~.Phone NO. ~..6'....?.~ Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor..../~....~....c~.. ................ 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 ) COUNTY OF ~: ............... ) S S. ................................................... /..~......~.~....,m..being duly sworn, deposes end says that he is the applicant (Name of individual ~igning a~p~ 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 oil 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 forth in the application filed therewith. Sworn to before me this ~ / ~, of ~~ ~,1~ ~;:'",:~ :'~;":~?:A' (Sianatureof applicant) .......................... ~, '"~ ......... Notary Public, .:~..~.~.:~ou~ty TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~ .~...c.:..,~.. ...... ~../.. 19......~.~.~ Approved ........................................ 19 ........ Permit No ............................... ~' Disapp roved a/c ........... ..'.~. · :.X,~Z~~~~~Z:~._~' ........................ .................... ......... Application No ............................. APPLICATION FOR BUILDING PERMIT Da e ............................................................ 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 and of buildings on premises, relationship to adjoining premises or pubIic 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 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 o Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ............................ ............. (Signature of appllcan~/or na ~me, if a corporation) ................................. ~,~.~¢'L..:.~..~ .............. .%~ji ..................... (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............ , .... : ........................................................................................ If applicant is a corporate, sign~ure 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 ..... f.~..~..~...~.~.~.~ ......... .(,~.'~ .................. ~ ............................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~ ........ ; ................................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .....~ ........Alteration .................... Repair .................... Re.~oval .................... 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 ...... Z. ................. 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 ......... .~,...O. ............ Rear ........ ../:'....~. ............. Depth ......~.....~C... ............. Height ....... f.~...(. .......... Number of Stories ...... ~ .................. 9. Size of lot: Front ......... .~..~.. ........... Rear ........ .~..r~. .......... Depth ........ ..J...~......,.. 10. Date of Purchase ................................. ./. Z.~. .. .~. .. ....... Nome ,o,f ,,Form. c,,er ~Ov~ner ....~..~..~.~.~ .......... 11. Zone or use district in which premises are situated ........... ~ ....... ~ ..................... ~ .................................. 12. Does proposed construction v,j,olate a~ny zoning law, ordinance or regulation? ....... ~ ..................................... 13. Name of Owner of premises ~ ............ ~...~....Address .~...~.....~..~one NO. ~..~..~..~....~..~...'~ Name of Architect ................ ./t~..~ ............... ~ ..................... Address ............................................ Phone NO ..................... Nome of Contractor ............. ~.....~'~. .............. Address ............................................ 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 whether interior or corner lot. ........................... ./~.~ ...... ~_~....~... .................. being duly sworn, deposes .and says that he is the applicant (Name~of individuSI signing appllc~ion) L above named. He is the ....................................................... ~.:i ................................................................................. (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 r~'gPne~'0~t~,,~ ~ f.o_rt h~,,,;~,..in the application flied therewith. Sworn to before this ..~: day of . ~.~,.~,3~,~.'¢,.~:'~,.'y ,(S,gnature of appl,cant) Notary Public,~..~.~'~t~:'"" : 7 ~&