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Home My WebLink About774-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building locoted at .~1~.~...,~..1~'.~..~.~'~,:~.~....~..~...'~1, .~,..~t~el~! Map No ......................... Block No ......................... Lot No ................................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated 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 ........ ;...!... (owner, lessee or tenant) of the aforesaid building. Inspector FORUM NO. a 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.° 774 Z Date ......................... ~...... 2~. .............. 19..~1~.... Permission is hereby granted to: ...... ~.u.~.~.e..~...~..?...e. ................................................. ........... ~,v.e~e~.¢.~....~,.~.,. ..................................... to ..~.~a~,..cu~..~...~,~,~r~g ............................................................................................... at premises located att~/.~..~g~..~,Y,'~,~.~...~T~..'?'.l~. .................................................................................. pursuant to application dated ............................... ,3~'......~. .............. 19..~..., and approved by the Building Inspector Fee $...~..*...0~.. ............. Building Inspector TOWN OF'-,%OUTHOLD P~OPERTY RECORD:~:CARD ::~:~::.-?~~ ~ · OWNER :~ ,_ STREET~ ,.~('~() VILLAGE DISTRICT SUB. ~" LOT FORMER OW hj-F~ R - - N ,-~"m -- %' ' ~ AGE BUILDING CONDITION _ , · NEW Farm . Tillable 1 Tillable 2 Tillable 3 . Woodland NORMAL Acre BELOW Value Per Acre Swampland Brushland HOUse Plot ABOVE Value ?/~ ~.~ Basemen, Extension - / ~--~.O{ ~ ~' I Ext. Walls ~tensi°n ~ ~ ~ ~ ~6 ~,, . f¢ Interior Finish Extension ?~:~ , qY ~ ~ FirePlace Breezewa' Patio R~ms 2nd Floor Garage /f ~ ~ ¢ ~ ~ f } ~ O~ Driveway FORM NO. 1 Examined ............ ~..~.~ Approved ..........~....~....? TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ........................................................................................... - · .................. ~:::'" ........ :'"':"':" ............................................. :'ZZ ...... (Building Inspector) ~,j~._~'~j ~ APPLICATION FOR BUILDING PERM~ ~._:'~ INSTRUCTIONS o. This application must be completely filled in by typewriter or in init and submitted in duplicate to the Building Inspector. / ~ , b. Plot plan showing location of lot and of buildings on premises, r~e. !l~idnship to 'bdjoining premises or public streets or areas, and giving a detailed description of layout of property md~t-bb;di'own on the diagram which is part of this location. c. The work covered by this application may not be commb~ed befdFe>is~,uance of Building Permit. d. Upon opprovol of this oppilcotion, the Building Inspector will i~fue~-~:~.~Bdin~' 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances gnd regulations. ~, (S g~ptura ~{~pp cont or name, f ~or~roE~) State whether applicant is ow~r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· If ~pplicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) i. Location of Iond on which,proposed work will ?e done. Map No: .,t~;:~.?.'+~.1';l...~:'::'.~.r:.4.~¢..~:,-..~,. ....... Lot No: .............. z '"'v, __ 'Municipali~ ' State existing use and occupancy of pre,hides and intended~use and occupancy of proposed construction: //// b. Intended use and occ pa cy ...... ......... ~,,..-~..,.//~ ......... .................................... D 3. Nature of work (check which applicable): New Building ....... ~....... ..... Addition .................... Alteration .................... Repair .................... R~moval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ....... ..~c~.~..~.~-~..~.~..~......~....... ............. 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, 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 ............ .~.~....'..~.."~epth ..,::~..~.. ........... Height ............................ Number of Stories ............ /~. .................. 9. Size of lot: Front ......... ,~ ____'~"'~ ...... Rear .../~,~.~,.. ~. "...~'~.. 10. Date of Purchase ...... L~,~t~,~,,~.~....~.~.~.~ .............. Name of Form~r Owne~.~.~...'..x~'.~t;~-~":s~.. ........... 11. Zone or use district ~n~which premises ar~ situated ................ '~....~-,~,~¢~,./.~.~..'~iC-- ----~ ............................. 12. Does proposed construction violate any zoning law, 9rdinance or regulation? ...... ~...., ............. 13. Name of Owner oi premises...~..p..(~/~...~d',r4ti~-r~ ......... ~"~~,'~e NO ..................... Name of Architect ......... ~~,_.~~ dress .......................... ~,.~ ~. ........ ~ho,~e NO ..................... Name of ......... .................. PLOT DIAGRAM Locote cleorly and distinctly oll buildings, whether existing or proposed, ond indicate all set-bock dimensions from property lines. Give street ond block numbers or description occording to deed, ond show street nomes ond indicote whether interior or corner lot. STATE COUNTY OF ,~..'7..,'J~.~'' ........................................... .C.::..../:.~.:C.'~...~.: ......................... being duly sworn, deposes and says that he is the applicant (Name of individuol~g a~l$6~'on) ~.,~_"~ 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 all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner se~f~l~th~, i~l~le application filed therewith. Frotary P~blic, State of Flew Yorl[ ~_, / j · flo 52-0344963. Suffolk County Swam to ef re e th~s ........... ..~...../ ..... doy of ................. ~~... 1 '9~'~'..'~"." ~),t,~'f~-'~ FOI~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ............. ~.~ ,/,g 19..~..~' Approved ............. ~[~~..,~ 19...c~...~ermit No ........ ....~.....Z..~...~.... Disapproved a/c ........................................................................................... ................_'('"";:'=, .......... : ::u__ .:_... (Building Inspector) Application No .......~.....~ .......... APPLICATION FOR BUILDING PERMIT Date ........................ 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 prope, rty must be drawn on the diagram which s part of this Iocat on. 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 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonce 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 Ragu orions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances ~nd regulations. · / ,(Sign~atu 'e 9r~pplica , r nam , if a~rporat~ State whether applicant is 0~, r,~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~,~¢ .~.:~...~m¢....!~' .................................................................... tf applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which,proposed work w~ill be done. Map No: ,~..~......'/'~.~.~.. ....... Lot No: .................... Street and Number ...... . .¢~..t~.;~.. ,ff,~..~..~,.~,./. Municipality 2. State existing use and occupancy of pre~nises and intended ~qse and occupancy of proposed construction: a. Existing use and occupancy ............. '.~.:'r~,c~~...~:',,..~ .................................................................. b. Intended use and occupancy ....... .~./...~....~: .... .~/;~...~.~m......~f.r~ .......................... · ......... 3. Nature of work (check which applicable): New Building ...... .X..... ...... Addition .................... Alteration .................... Repair .................... Removal .................... D~molition .................... Other Work (Describe) .................... 4. Estimated Cost .........,~..:..y...w..~.¢~.z .......................... Fee ....'~../.Z~..i..; ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............/.~ ........... Number of dwelling units on each floor ..................... ../. .......... if ,arage, 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 ............................... Nqmber of Stories ................................ 8. D mens ons of ent re new construct on Front ..... Rear ........... Depth ..................... Height ............................ Nu.,mber of Stories ........... ./. .................. , / 9. Size of lot: Front .........~/.~ ...... Rea~r ...../.~..,~,..~.'..~...,. Depth/.. ~./.~...J:..~..-~/...C,~* 10. Date of Purchase ...~-~.Z~ .............. Name of Former Own~)>~~ ............ 11. Zone or use distr.ct m which premises are s.tuated ............... KN....~.~Z....~..~.~ 12. Does proposed construction viol~ any~zon[ng law~rdinance or regulation~ ...... 13. Name of Owner of premise:..~~~~[]~ ......... ~~e ~0 ..................... ~ome o{ Architect ........ ~~.~dress ...................................... ~h~e NO ..................... .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existMg or. proposed, and indicate all set-Back dimensbns from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corne, r lot. /~ ~,/~ OF S coup"r,,, oF '. ............................................... :..~~ ........................ being duly sworn, deposes ond soys that he is the opplicont above named. He is the ........ ~ ....... ~~.."3~... ...................................................................................... . , ~x/4--~ (Contractor agent, corporate, officer, etc.) of said owner or owners, and i~ duly authorized to perform or have performed the said wor¢ 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 manner set f9li~uirt, ti~epplic, ation filed therewith. Sworn to before e th'~0t~ y pull,c, State o~ New ~o~) -- ........... ;~..~ ..... ~~~do~ of ................... ~,. 19~-~.~... '-~ ~- ' Notary Public,~~~o~,,,,~ (Signature of applicant)