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Home My WebLink About804-zFORM) N;O. 4 TOWN OF SOUTHOLD I~UiLDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY No ...... .~...(~ .6.1 ...... Date ..................... O¢i;o]~ar...20 .............. 19~0.. · THIS CERTIFIES that the building located Map No. *~t..*. ............ Block No. **'~' L '" *~'* ....... . .................. o[ iNo .............................................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. .A.~.~.-.s.~....!.[ ......... 19.~.9... pursuant to which Building Permit No...I~....~.0..4. ......... qated AUgUSt 13 19..5..~., 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 PRIVATE~ OW FAMILY' DW~LLING This eertificale is issued to ....C...e.~F.i~...q..~!~....~ti.~!l~l,_...O~.n~r ........................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspectm1 FOI~I 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) N°, 804' Z Date .............................. ~.t~...~ ...... 19¢~.. Permission is hereby granted to: · .~z~.~...C....~L...Wie~e~ ..................................... · .~.t;.%l~:~tCk~..Ne.~..~rk ................................ to bu&l&. ~:~z.. ~'~s~, f,~il~v.., s.~c'c,e ~...hc~e. .............................................................................. at premises located at .~/s...~.z~.iv~t~.,Pcaa~,-..e~s.~..e~...Pe:z~k..:A~*e~e.s .............................. Mat, titu¢,~ New ~ork pursuant to application doted .................................. A~¢4~.~8.~...~.~ ........ 19.~..., and approved by the Building Inspector Fee Building Inspector ~O~ARD M~ TERR~ TOWlq OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. Disapproved APPLICATION FOR I~UILDING PERMIT . INSTRUCTIONS a. This application must be completely ~itled 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 coYered by this application may not be commenced before issuance of Building Permit· d. Upon approval of this application, the Building Inspector wJlJ 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 port for any purpose whatever until o 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances end. regulations. C oH.~Viokham (Signature of applicant, or name, if a corporation) ~attituek, N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises....O, ad.~ia..H,,.).~i~kham ..................................... :.[ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and tide of corporate officer) 1. Location of land on which proposed work will be done. Map No: ....... ~x;;C.;f ....... }"~ .................. Lot No: .¥.¥. ............... Street and Number ..~./.~,.~.r~.~..~.oa.~.'e...~..¢zt~..~k..A.~,....,~.~.~i~.~ok~..~.,~., ................................................ Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy....~.qF.~....1,q.~ ............................................................................................................. b. Intended use and occupancy ....... ~.~t~??..h.q~.~..e. ................................................................................................... ..... ~,,cn applicable): New Buitding....~ ......... ~Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to be paid on filing this application) 5. ~f dwelling, number of dwelling units ...... .9.~.e. ................... 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./l~Hmensions of.entire ,new construction: Front ............ I,L0~.0. ....... Rear ...... lh0..-.D ............. Depth '~ ' Height ~dS.t,:..-r.~:.o.nt...~.?~:.i~-f4umber of Stories ......... o~,a ............ + 11. Zone or use district in which premises are situated ......... ?A.?..,~a~,d,~z-t'~;i.e,~ ......................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? .................................................... Name of Architect ........................................................ Address ............................................ 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 ar description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW, YORK. ) S S. :,....i .................................. .Q.~.d.~C,~,.~[,,..~fiJf~ .............. : ...... being duly sworn, deposes and says that he is the applicant (Nome of individual signin~ application) - 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 ail statements contained in this oppllcotion ore true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the opglicoti,on filed the~w, ith. Sworn to before me this , ~ /z ' '~¢~-~ ~ /~'~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .......... Disapproved o/c ...................................... ............... ~~ ......... ~:. V Application No. ~--~/'- APPLICATION FOR BUILDING PERMIT Date ....................... A~g.gfl~ ......~ ............... 1 9..-~.~. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building ]nspector. b. Plot plan showing location of lot and of bui[dlngs 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 port 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and .regu]ations. (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 bbilder. If applicant is a corporate, 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: 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....V&~.~r~.t~..lo:b ............................................................................................................. b. Intended use and occupancy......fl~l~tt~ftZ'..gglg~ .................................................................................................... 3. Nature of work (check which applicable): New Building....~ .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4." Estimated Cost....$200.Q~,.0.0 ....................................... Fee J'..~0.~.0.0 ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......~t3# ................... 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 ............ ~O..-.O ....... Rear ...... ~&O.?.O ............ Depth ....2)4..'..0 .............. 12' f~om s~l~ , Height ]..j~e...~Z,OtW.S.~t3~umoer of Stories .......... O1P,~ ............ 9.' Size of lot: Front ...... 120, .............. Rear ...... :[00.....' .......... Depth ....3,.~.0....-....1~.~.18e®33 10. Date of Purchase ........ ..~.c).].~ ..................................... Name of Former Owner ..... ]~.~.¢~Ji..~.t;J3~,],l-, ................. 11¢~ Zone or use district in which premises are situated ......... ~A.~...re~l::l.6ei3t4t~l ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises.(].~.d.~;l,~.J~....i.W.;t.q~..h..e~.......Address ...!~...t..~$..~.~9..~. ........................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... ' Name of Contractor...tO..~,..~.(~J{h~z& ................... Address .....~l~Jl, J;&t~t,t~3~ ................. Phone NO..~[e...~..'.J~O PLOT DIAGRAM Locate clearly and distlnctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property Hnes. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. \ \, STATE OF NEW YORJ~, ) S S ' x COUNTY OF .~..~/..f..o..1.~. ........... ) · k ........................................ .~.~.¢l,l~.~..~[~..~hall ..................... .~eing duly sworn, deposes ~nd sQys that he is the applicaht (Name of individual signing application) above named. He is the ............... ~ ................................................................................................................... ' ........ (Contractor, agent, corporate off cer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fil this application; that ail statements contained in this application are true to the best of his knowledge and ~'eliet and that the work wJJl be performed in the manner set forth in the application filed therewith. Sworn to before me this ~. ~Z~ Z ~ ....... day of ...~~19. ~ROV s~. ~$~n~pre. . ?o,f,, ~.,.,~PP cant) ........ .~ .~.~ ~otar~ ~b~ ~. ~h,: or ~, ,,r , ..,, , Nota~ Public, . ........ ~..w.~ County Suffolk ~':