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Home My WebLink About649-zFORM NO. 4 TOWN OF SOUTHOLD BUULDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....~...i..~'....0. .......... Date ........................ .~...e.~..e..~...~..e.r...~.. ......... , 19...~.?.. THIS CERTIFIES that the building located at..~...~..~..~...~...,,~.~..~..¥.~.....~.'.?..~..~,..~.~...,~.,,O.~..~..~.~.J **** $6 & Imr~ o~' ~7 Map No.(}...O..O.,,~.,~... ~.e.~.~.. Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... .~.?.?...~..~.....~..~.. .......... , 19.....~.?., pursuant to which Building Permit No ...... ~...~.br.~. ........... dated ........................... ..~.~...~..~..~.....~...~. ....... , 19..~.?..., 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 .............. r~ATE ONE F~/~ILY DWELLING This certificate is issued to Edwa~'d ~itet o~ez' (owner, lessee or tenant) of the aforesaid building. HOWARD M, TE~RY FOI~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) 649 Z Permission is hereby granted to: pursuant to application dated ........................... ~.]~......~.~ ................... 19~..?...., and approved by the Building Inspector ~ ii ....... l_-t~,~m~ ......... ~. .......... ~ ............. ~. .... Building Inspector ~ ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ] 9 ........ Permit No .................... Application No ...... .~... ~:~..! ............. (Building Inspector~) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~. This ~pp~iccztion 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 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. State whether applicant is owner, lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. Name of owner of premises ..... ~ ............................... , .................................................. (~me ~n~ title o~ corpor~e officerl Municipality 2. State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ~~..~. ..................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ........... ~ ....... Removal .................... Demolition ............... ;.~,~Other Work (Describe) .................... I~'ll ~''.,. (,.~,, 4. Estmoted Cost!.~...~...O. ............................ Fee ................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......~ ........... Number of dwelling units on each floor ............................ rs c~1,/,,~,...~ If garage, number of ca ............................................................................................................................................ 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 ..~ ...... 9. Size of lot: Front .......~ ............... Rear ....... ~ ..............Depth / ~ .7.Z..'? Z~o 10. Date of Purchase ...~~.......'~.....~. ................. Name of Former Owner '.~..'.~(.f.~t.~.~..~. .............. 11. Zone or use district in which premises are situated .......................... : .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ...~...~. ..................................... 13. Name of Owner of premlses.c:c~,r~ ............................. Address ...................................... .~....Phone NO ..................... Name of Architect...~.~..~....~..~?....~:~.....~(. .................... Address ............................................ Phone NO ..................... Nome of Contractor .... ..6~...C.. ~...Address ..... ~r..(: ............ 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. STAT OF dC- ) S S COUNTY OF ....:~.~'J, cL-~] ...... ) ' ............................. ~r,,~.....~' ................ being duly sworn, deposes and says that he is the applicant (Name of~ndivid~aK sign'm~ ~I~~ obove homed. 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 application are true to the best of his knowl~g~nd belief; and that the work will be performed in the manner set forth in the applicatio~fi[e~t~erewit~ Sworn to before me this ~ ~/ ~/~/~'~~ ' ~*~ day of ~ 19 ~ ~ J~plf~ T~gna/ure of applicant) ...................... . ~.~,,-~ . ~ ~ ~ ' ~otary Public, State of New Y~rk . ~~ /. ~.z ~ NO. 52-0344963, Suffolk County FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r. xam nea ......... ~;....;~.....' .................. iv ........ Disappraved a/c ...i-....~ ........... .x~ .............. ,~':-~,. ............................................. ....... :-.'?..::~: ......... .:.:.:.:.\ .................................. (Building InspectoF) Application No ............................. APPUCAT~ON FOR BUILDING PErMiT 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 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 p art 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. ?-~,.,w.,,..,f~, ....... ~ [~",,w ,¢'-¥~,,,.4,~v (Address of applicant) State whetfbler applicg~t i_s__gw._~r~_eF.~,_lessee, agent,' architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................................................................................................................................................... If applicant is a corporate, sign~;t,ure,of d~ly authorized officer. ~,./ ., w I d /, ./:? ". ,: ./ .......... .£:../.,X?/...:.,.~..~.~,..~:~ ...... .? , .,, ~ ~' (N/~mf' and titl~ at corporate officer~ 1. Location of land on which prop9~sed ~,.ork will be done.~Map' NO: ..... :'.-...;¢.'...~..v ......... ~ ......... Lot ~1~: .................... Street and Number ...~.??.:..~':.~.::./.!:}....~...~..~..' ...... ..~.:4.-:~...~...:~:!~! ................... ~:~'~:!:~:ii::.(:. ......... :Ii::i.t..................... Municipality State existing use and occupancy of p~rnises and intended ,ute c,/nd occupancy of proposed construction: a. Existing use and occupancy ........ ;.";:'.;,....t~ ........... :...~...; ............................................................................................ b. Intended use and occupancy ............................................ ~ ................................................................................... 11. Zone or use district Jn which premises are situc 12. Does proposed construction violate any zoning Oq 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ........... ;,. ...... Removal .................... Demolition .................... ~Other Work (Describe) .................... 4. Est mated Cost·./..~:/ ~ ~'). 0 .......................................... 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 ........... .c~.~.~..~:..".~. ......... C...r..~..r.~. ....................................................................................... 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 ~-..~......,~...Z~.. Height ............................ Number of Stories ....~....~.~.~..:~ ..... Size of lot: Front ........~..~.f~} .............. Rear ....... .~..~.? .............. Depth .../..?...~...:¢...~...~?... ..... Name of Former Owner 't '~"~:'~"~' '~ · ..... · ~:..~ .............................................. Locate clearly and distinctly all buildings, whethe~ property lines. Give street and block numbers or descri whether interior or corner lot. STATE OF NEW YO&K~, ~ ) S S ................ ........ abaw named. Ho the ......................... ~w, ordinance or regulation? ....... ..~...0.. .................................... ..... Address ~/.f.'.~/.P.....(~.f.~4..S.~.~;~".:~.?Ml....Phone NO ..................... ..... Address ............................................ Phone NO:~ ................... L.Address ....~.~:~.t-~...'.-.:~/..:.~..' ............... Phone NO DIAGRAM ex isting or proposed, and indicate oil set-bock dimensions from ~tion according to deed, and show street names and indicate ~d ...... being uly sworn, deposes and says that he is the applicant ntractor, agent, corDorate officer, etc.) of said owner or owners, and is duly authorized to per arm or have performed the said work and to make and file this application; that a I statements contained in this ,~pplicotion are true to the best of his knawlgC~ge gnd belief; and that the work will be performed in the manner set forth in the opplicotion,~filec~t[~rewit~.' /'//:/~ , Sworn to before me this /n .............. ~.~... day o~o~ff_~ ................... .~¢,~.~,<~;~..~19~..~ ...... JUDITH T~. ~gina/re of applicant) ~ ..... ~ / /2 ' .9 '":~("'~.~4z* ._ Notary Public, State of New/York INotory YUDIIC, ...~../,¥..~....G~-..~-~..,4~.¢~'~..~,~ No. 52-0344963, $~lffolk