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Home My WebLink About643-z TOWI~ OF SOUTHOLD BUILDINC, TOWI~ C/.~ERK'S OFF~CE $OUTHOLD, ~, Y, CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at C~.~...~lgl..d~...e.,lg..d.,..,.~. ~.d...A~'f~l~et Map No. e~* Block No ...... ~.~ ........... Lot No. conforms substantially to the Application for Buildin~ Permi~ heretofore filed in this office dated ................. ~!~...$.~ .............19..~.9. pursuant to which Building Permit No .......... dated ............... .............. Was issve~, a~d conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is ..................................... ~.~...0~ F~LY T~s certificate is issued to El~he~k.Ra~a~,....~r ................................................ (owner, lessee or tenant) ~f the aforesaid building. ....... . .f~,,~ ..... : ..... ~.'~,.~ ................. Building Inspector FOI~M NO. 2 TOWN OF $OUTHOLD 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? 643 Z Dote .......................... ~ ~.~'J,1.....S0. ............. I c~ ..... Permission is hereby granted to: ~Xfrecl ~e..~ki ~/.~ ~ ~,~.'ge.~.,...~ft.~.~ ..................... ...~kt.~,....~.:~.: ............................................. to ...~.!~..~ ..~ ~,t. ~.o.:.L ~...r..~.o. ~.,. ~....~.~?.~.e..~:....~ ~.t,~ ~.e. ..................................................................... ut premises Iocoted ut .~'~.~,~-~..~.~.D..f.~..i¥,i~.~.~-,~...~.~ .................................................................................. ~,~ttttuek~ ~ ¥ pursuant to application dated ............................. ~Y..~J~....~ ................. 1~9....., and approved by the Building Inspector ................ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~..~...... 19..'~..¢ Approved ......... ~..~.....19...~.~..Permit No...~z:~...,.¢~,,./c)~.... ......... Disapproved ~_~ ...... ~_~..~_f~__ j,.~ (Building Mspector) /~¢,/.~ Application No .......~......~..~ ........... APPLICATION FOR BUILDING PERMIT Date ............................ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted [n 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 be/ore 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable taws, ordina,nf, es and ~.gulations. ....... ...... .................... (Addr~o f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ....................................................................................................................... If applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wor~.~_~, ~/// ~¢/,/~ . /~/¢,~will be done~__~ap No: ,,d) ................................ > ........ Lot No: .................... Street and Number :(L~.~.~..'~...':..~=.~.<..,~...'./~./..~.~~.-..-~-..z~..~I.¢~....6'..<:'~%.~...: ..................... Municipality 2. State existing use and occupancy of p~emises end intended use and occupancy of proposed constrgc~jo~~ o. Existing use and occupancy ..... ~~...~:. ,c ' b. Intended use and occupancy ................ ~.¢~-~ ...... ~ .......................................................................... 3, Nature of work (check which applicable): New Buildin~ .................... Addition .................... Alteration .,.,,.~,,,[~ Repair .................... Removal ....'~..i ............. Demolition .................... Other Work (Describe) .................... 4. Estimated tosr...-..~ ................ : .................................. tee .......................................................................................... (to be paid on filing this application) ,5. If dweIling, 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 .............................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ 8. Dimensions of entire new construction' Front '~' / Rear -- '/ Depth 10. Date of Purchase ......................... ' ............................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction/,)// ~) _..,violate on~, zor~i~nc~ law, ordinance or regulation? ...~.J.,.....'Z. .................... 13. Name of Owner of prem ses..C.;. cYd s ........ Phone NO ..................... Name of Architect ................. ;,~ ........ ZS.....,..~ ............ /~.Address ..................................... :~ ........ Phone NO ..................... ~ // PLOT DIAGRAM Locate clearly and di~f4'nctl¥ oil buildings, whether existing or proposed, and indicate al/ set-back dimensions from property fines, Give street and block numbers or description according to deed, end show s~reet names and indicate whether interior or corner lot. STATE OF NEW ¢xCOP,~4~ ,¢~ ) S S COUNTY OF ,~) ' a b ore n a n(,eN~ mk,ee :i t i~ed, ':~4"~ ...................................................................................................... (Contractor, agent, corlSorate 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 a~d belief; and that the work wJ[I be performed in the manner set forth iq the application filed therewith. Sworn to before me th~s ......... FORM NO. 1 TOWN O~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~c~ ............ 19. L~../.~.. Approved ........... ~~..19,.~.~...Permit No....~..~.~.... ....... Disapproved a/c ................................... ~...~. ......................... ............. ......... Application No ........?......~... ........ APPLICATION FOR BUILDING PERMIT 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 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 in part for any pukpose 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 appli~:able laws, ord nances~ and reaulatlons. ~ (Address o~,~6pplicant) State whether ap~tect, engineer, general contractor, electrician, plumber or builder. Name of owner of premisos....~,'~...' ......................... If applicant is a corporate, signature of duly au'ffEorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be donee, Map No:,,~ .................................. ,~......~. Lot No: .................... Street and Number~...~~'~'''''~'''~~:'''~'''~:...~ ............. Municipality 2. State existing use and occupancy of pr,emlses and intended use and occupancy of,,/.~ ~ ~.'~,.pr°p°sed co,ns~cti~o~:' a. Existing use and occupancy...~.~~.~~m.~..~,~ b. Intended use and occupancy ........ ~.~....~...~. .................................................... 3. Nature of work (check which applicable): New Building .................... dition .................... Alteration '/'*' Repair .......... ...~-...Removol .....~.......Demolition .................... Other Work (Doscdbe) .................... 4. [stimated Cost.......~..~.....~.......~......~. ................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units....~....Number of dwelling units on each floor...,.~'.,....~'....;...?,~.,..r... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify n~ure and extent of each type of use .............................. 7. Dimensionsl ~lg~'~°~ng structures, if any: Front.~~ ....... Rear ....'~...~..~....~.....: ...... Depth ......'~.....~... .............. Height/.,llR~T...;~:. ....... Number of Stories ..... .~. ............................................. · ......................................... .......... Dimension>df same structure with al~rations,z.~ or additions: Front ..____...~...L'.~.; ........ Rear ....O~...../. Depth ....... ~ .................. Height .../~......:~....: ......... Number of Stories ...~...: ........ '~'"' //' Dimensions of entire,, new construction: Front..~.~..~Z .... Rear ...~..../~..~: ..... Depth ../...~'~...~.: ..... Height ..../..~.....~....:.... Number of Stories ..~....:.... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction~,o ~' ~ ~-, ~-.. z-/vi°late ~any zoning law, ordinance or regula, tion? .,..~....::. ........................ 13. Name of Owner of premises.~¢,~..~~~ ............ Phone NO ....... ': ............. Name of Architect ..................... ._ ......... ,~.~ ................. Address ......................... ~ .................. Phone NO ..................... Name of Contractor~J~.'.../,~dress .~'~J~..~...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. STATF OF NEW ~P,K,,., .~/,)' S S COUNTY OF ..z~,~.~¢(~::,),~ ' ..................................... ~.~:.~--~ ............. being duly sworn, deposes <md says that he is the applicant (Name of indi~l ~igning'~pplicati~n) 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 app cation; that all statements contained in this appJicatio~are true to the best of his knowledge and belief and that the work will be performed in the manner set forth ia the application filed therewith. Sworn to befor~me th~s ~ ~ ~ ~,, ~, .. of ...... of .-..x / // ,