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Home My WebLink About655-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ............ Date .................... ' ............ ~.¥...,~,..~. ......... , 19.....~,./ THIS CERTIFIES that the building located a~../~...~.g.1].t;...e...~.~..~/...~..~,.zl..~..~..~.,~...~.?-..~...~. ...... Streert Mop No. *** Black No ......................... Lot i'~o .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ ................ ..~.~.~.~...~.~ ............. 19...~.9..., pursuant to which Building Permit No....~.....~...~.~ ............. dated ............................ ..~.~..~...~.~....~..~.. ...... , 19 ~'9 was ,s e' and onf r ...:...., ' su a, c o ms to all of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .............. ................................................... ............................................ This certificate is issued to ...0...~..~.?...~..~..?.?....~.,~....?.~..~..~,~.,,~.,~..?...?...~...?.~. ................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FO~M NO. ~ 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.° 655 z Permission is hereby granted to: .... '......%.~ ......... ;.~ ......................................... ................................... ,..., ...................................... ~ .................. t,...~ ............ ~ ........... at premises located at ......................................................., . ; ...................................................... . . ............................................................. .~...q'.L,:.~:.:-.~.~;:;.~. ........ ~:~..'. ............................................ pursuant to application dated ........................... ~....?...?. ............. 19~'...~...., and approved by the Building Inspector FOI~M NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL File i"Jo ................................................................... Do~e ................................ 19.. ..... ........... ~wap ........................................ Block ....... ~]?T....~ ........................ Lot - is ~ disapproved on the following grounds ...... ~ ...... ..... ~......~...=....~~..~.....~.: ........... ~ ............................................. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .. ..c. .... ~M-. ........... ~ ............................... ................................... (Building Inspector) Application No.....~.~.. ........... APPLICATION FOR BUILDING PERMIT ........... INSTRUCTIONS a. This application must be completely 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 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 covsred 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 Sou'thold, 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 all applicable lows, ordinances and regulations. ...... ~,:: ../.:fr..~:.:.::..::.....~T~.:.~L,:~: r'='. ~...:~.....: .................... (Signature of applicant, or name, if a corporation) ............. ~~:....._.., ......................... ~ .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ?.~..~...~ ........ Name of owner of pre mises ..................... ~ ~. ~.'¢~"". ....... ~.'. "(."~*~/~',f-.¢.-~-.~,'.'' ,* ..... ¢~.* ......... ~.~'~' ¢~'.~' ........................ If applicant is a cad, orate, 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: ............. ' ....... ........ .............. ....... ............................................... Municipality 2. State existing use and occupancy of pr,emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occ.pancy ................................................... ~. ¢...........~ 3. Nature of work (check which applicable): New Building .................... Addition ..... ( .......... Alteration .................... Repair .................... 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. [f business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ....... ~..,~..~ .......Rear ....~.~...:..'m.. .......... Depth .....~.~/....*.-:'.. .......... Height ......~.~.~..~..-. ......... Number of Stories ........... ~:,.¢~:.....~. .................................................................................... Dimensions of same structure with alteraHons or additions: Front ......... ...~....'~.~*..i..'t1'.. ....... Rear ....4....~....'..~.... ............. -- , - , ....... Depth ....... .~.i~' .............. Height ....... .2....~....-m.. ........... Number of Stories ......................... 8. Dimensions of entire new construction: Front ........ ../.,~.~'.:..-~.. ........ Rear ..... ./.i~':...~-t.. ............ Depth ..../....~...~..~....~? ....... Height ..../...~.....--n.. ............. Number of Stories ..... ~¢.-.~.. ....... 9. Size of lot: Front ./.~...~..~.:'~¢.:.--... Rear .../~.~..~....~'.,~. .... Depth 10. Date of Purchase ........................................................ Name of Former Ownerr.~.);'(.~::~.fr;~...~.~.Z~.~.~..~:/...: ............ 1 l. Zone or use district in which premises are situated ................ ,C...! ............................................... ~7'~. ..................... 12. Does proposed construction violate any zoning law, ordinance or,r,eg,ulati9n? .... :~....;'.~'.....~.....~..~.....'~... ............... 13. Name of Owner of premlses..~.:..J2.¢/..~.~:.'' ....... Address ..~('!~~..~.'.;~ ....... Phone Name of Architect ............... ~.~..../~.....'~.. ...................... Address .............................. Phone NO ..................... Name of Contractor.~v~/~.~.'~..~;'..~.:Z~.~.'..~,,~i~.:~,..~..~..~.?~?,Address .~¢~42~,.';{'('..~¢...Phone NOfIV~.~...-.~:.~.~...R' 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 n.qmbers or description according to deed, and show street names and indicate whether interior or corner lot. ~ ............ :.`.~.~`~,.~L~?~.;~..~`~`~/~./..~'~'.~.~.¥~.~w``~?..;~?~:.~:~`~.~`;being duly sworn, deposes and says that he is the applicant (Name of individual signing applicati~on) . above named. He is The ............ (~.-r,,¢.,'r,;~,,J~.,¢.,,¥,.,-,,,,;.,,.¢ ...... , ................................................................................................. (Contractor, agent, corporate officer, etc.) of saki owner or owners, and is duly authorized to perform or have performed the said work and to make and fife 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 forth i~,tt~n~j.C~;~licatjgn ~fi/led therewith.,, ,,, j Sworn to befo~lLe me this .~'~sLc, s~ O~ ~.~' .... .~'.~ .~. .... day of