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Home My WebLink About776-zFOI~i~I NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ~o ...... ~... Oote ......................... ~.e.~.~.~..~., 19..~.~... THIS CERTIFIES that the. building located at .~..~.~.~,~..~.~&~.~.~...~;~.¢..~...~.~..~.~.. ~,e~]r~O~ Map ~.~,~..~..~U~.~ock ~o ..... .*..*...*. ............. ~ot ~o ....... ~...~..~¢.. .......................................... this dated conforms substantially to'the Application for Building Permit heretofore filed in office ~ ............................... .d~...]....~...~ ........ , 19..~..~.., pursuant to which Building Permit No...~..~.~...~.. .... dated ............................. ~.~...~ ........ 19....~.~, wa~ issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ .......................................................... P~...0~..FAMY~ .~ [~T~,t{(~ ...................................... This certificate is is'sued to ..,.~..~..~..~.~..~.~,~.~.1~....0..~.~..~.~. ................................................................... (owner, lessee or tenant) of the aforesaid building, HOWARD FOR.FI NO. · TOWN OF SOUTHOLD BU|LDING 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? 776, Z Date ................................... ~...~....~. ........ ~9~.9. .... Permission is hereby granted to: ~.t.~f.:..,.L.~.,..,.~...~..~..~.,.!~?..? ................ ~x..91_~i~le..I~l~.~..~..~.., ............................ to ...... ~.a. ll.4..~.d..d.l}l.o.~..~..~..~.....~l.~!~.g ............................................................................. at premises located at ..~..~..~/...i~i.i..~..d.~:..~.&.~..P...i~...~..~@~...~...'t~.~.~..~...~/.~..h..~.g~..~.? .................................. pursuant to application dated ................................. .$..~..2...0. ................. 19.~?.,., and approved by the Building Inspector Fe~ $..~..,~..~.i.~ .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. Approved ............ ~~...19~....~Permit No.....~...~-.....~....~.., ...... Disapproved ,/c y~.~: Application No ..........~...-~'~.. ....... 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 progr?ss 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~,~ // ~ ~ 7~,) ~/ .................................................. ~J (Sian~cant~.~j~ame,,~f a ~orporad~n) ~,,,~.~.....~...f.¢...~.....:..4..~,...;.. 7'-'"'-r-' ...-~ .............................. ................ 7 ...... ('X;i;~res"- ' ;;';;F~'~;~;'ii~:;~;;~)' .............................. State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ................... ................................................................................................ Name of owner of premises ........... ~...~.. k~/'~ '~ ~' ''~' ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,oca,,on of ,and on wh,ch proposed work w'" be,one. Map No: 'at No: Street and Number .'~'.~.:.~.~...~.d¢.~....L.~..~..~....~...., ..~,.?..~. ~. ~...~.-~..~..~.. 4~..,~.e. ..... ~/~,_.r,~ ¢.~...~...~..r~ / ,/ Municipality ..................... ;* .................... 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: J a. Existing use and occupancy ,/~ 6' b. Intended use and occupancy /~',~ 3. Nature of ~work (check which applicable): New Building .................... Addition ..... lcd.. ........... Alteration .................... Repair .............. L....Removal .................... Demolition .......... ~.......~O~her Work (Describe) .................... 4, Estimated Cost...~.~.~. .............................................. Fee ...~.~... ................................................................................... (to be paid on filing this application) 5, If dwelling, number of dwelling units ........... ~/~-.-~:~,'7'l .......... Number of dwelling units on each floor ............. .?. garage, number of cars ........................... .~......c~...~." ............................................................................................. If 6. If business, commercial or mixed occupancy, specify nat~.re and extent of each.,type of use .............................. 7. Dimensions of existing structures, if any: Front: ......... f..'Dr....r-/ .......... Rear ....... ~;-.~' ........... Depth ...... k.~...~.~..,......~C,.... Height ............................ Number of Stories ........... Z ...................................... . .............................. ~'"Z'; .............. Dimensions of sarr~e~structure with alterations or additions' Front "~47 Rear //~/,d r/ ................. } .............................................. Depth ............. . .~../......~..'... Height .............................. Number of Stories ................................ 8. Dimensions of entJ. re new construction: ran ............................ Rear ................ .z .......... Depth ............................ Height ............ ~. .............. Number of Stories ........ .?.. ............... 9. Size of Iot: Front o'~d.) Rear ~ ~ Depth ~..~d~.~,..~, 10, Date of Purchase ............. l~.,..J~...~.. ........................... Name of ~Fq~/me~ Ow~er. ~-.?....~..~. ...... ..~....~....~,..~...~....~....~.. ......... 11. Zone or use district in which premises are situated ............... ~.. ....... '/~ "~/ ~..~4~...'...~.'.'...~.~: .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... Z/.TZ...~.....: ........................ p re m ises..~.~.....~..~¢1~..~...~.~.... Add ress' O~x4, ~ ~ ~ NO7~.~ ~.:../...~. ~ .Q 13. Name of Owner of ~.~..:~:....~,~'.....~./.~..~¢..,..Phone Name of Architect ........................................................ Address ............................................ Phone NO ..................... Co n t r a c t o r....¢k~?~ .~',x~z~ ~, ..~ .'~' Name of .......... Address NO. PLOT DIAGRAM ~-'~ Locate clearly and distinctly oil 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~l, lot. ~.jl STATE OF NEW Y~D~,K~/ COUNTY OF ,-.~s.,~.~.~-.~..~,~~:' ' ........................... ~.(...~ff.,.-~.....t..~...[....'..~..~...::..~:k? .............. being duly sworn, deposes and says that he is the applicant (Nome of individual signing,application) above named. He is the .................. ~..~--~¢~'~-.~'~':.,,~.d~,~."~,-.' "' ................................................... ',~ ..................................... (Contractor, agent, corl~orate off!,c~r, etc.} I of said owner or owners, and s duly authorized to perform or have perfgr~,ed the said work/a,~)to make and file this application; that oil statements contained Jn this application ore tl~ie _t6~ t,}~' best of hj~ ,J~ow[edge and belief; and that the work will be performed in the manner set forth in the a~plic~id~/filed therew)~['7'~ Sworn to before me this / Notary FORI~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. Approved ............... ...~~t~-.~'~.. · Per m it No ....... ~...-~..~....~..... Disopp roved a/ c ....... ~,;.; ~,~.~i....~.i.~.~~~.~..:: ...... (Building Inspector) ~' '-~-~' Application No.....-z~..~., .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate fo.-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 to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Ordinances or Regulations, for the construction of buildings, additions or a fferations as herein described. 'The applicant agrees to comply with all applicable laws, ord inances iht, or name, if a corporation) (Address of applicant) ttate whether applicant is owner, lessee, agent, a~rchitect, engineer, general contractor, electrician, plumber or builder. ......................... .......... ......................................................... Nome of owner of premis: : If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which,~r,~p, roposed work will~z~be done.~Map, i~C'~' No: ... ~/.. Lot No: ...~.~'~ Street and Number ............. Z ....... ~r~ .............. ~. ........... ~ ............. ~...~ ............... ~....Z~ ................. ~ ....... M~nicipality 2. State existing use and occupancy of pluses and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. ~.~.'~..~Z~..C..f~'~ ............................................................................. b. Intended use and occupancy ........... ~%.~.(~..¢'~.~..~ ................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ......~....] ........ Alteration .................... Repair ................... Removal .................... Demolition ......... ~ ....... .Other Work (Describe) .................... 4. Esti mated Cost.......~....~..~..~ ............................. Fee ./Z~.~. ~ ........................................................................ (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 ..~....7..T~.~ ........... Height ........... ~...'i ........... Number of Stories / .............................................................. Di'mensions of sam~ structure with alterations or additions: Front ........ ..~:.....~.. .............. Rear .,~.~ ................ Depth .......~...~....-/....~.. ........ Height ........ ./...(-) ................ Number of Stories ...... f ......................... 81 Dimensions of entire new construction: Front ........ ~...~ ......... Rear ...... ?..:.~ .........Depth ...../...~ ........... Height ......... ~ .............. Number of Stories ......... / ................. 9. Size of lot: Front ........~ ........ Rear ........ ~ .......... Depth 10. Date of Purchase ...........,~..~..~,q~ .~..~ ............................ Name of Former Owner ........ ~/.#,,~....~.....~t..~./-/.~.~ ......... 11. Zone or use district in which premises are situated ............. ~. .............................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ..... ..~'...O.. ........................................ 13. Name of Owner of premises...~.~..O...~...~..~.'~....~(..Z"5..Address ........ ./'~..~.....~...¢..~.(~...~i(. ........ Phone NO."~.6~..~./~.~ Name of Architect ........................................................ Address ............................... j/_? ...... r'none NO ..................... N a me o f Cant ractor......~..M_~....G../.: fl..~.~,:.../(~¢;.~..:.. Add ress. ~...~.?.7......~.. t.' ..~....~.~./~'"~"~ Phone NO. .~.....~.~.~/' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali 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 NEW YORK, ~ COUNTY OF .............../.,O,__.~,.,,,f///,,,,,,r..~i~......::) - -1 ~ ......................... ~..,~.'.('...~..~.'..~..~....~...:.. .......... being duly sworn, deposes and says that he is the applicant (Name of individual signin .j~gpplico~n) ~ above named. He is the.. .(.,,~..'~/.: ........ : .......................................................................................................................... (Contractor, agent, corlborate officerc,¢c-3~. ~. of said owner or owners, and is duly authorized to perform or have performe/d~ ~e sale/work an~l to4fffF, ke and file this application; that all statements contained in this application are true/to t f ~,est,/of his kn/~wl,c/,~'ge and belief; and that the work will be performe,~ in.the manner set forth in the appli96tio~ ~1,~ ~herewith. / // Sworn to before me this ~ / / / // ' ,~. / ~' / '~I