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Home My WebLink About562-zFO~M NO. 4 TOWN OF SOUTHOLD BUILD~HG DEPARTMENT TO~VH CkERK'S OFFICE $OUTHOLD, H. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located Map No.. ...... ***.......... ...... . Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore flied in this office dated ..................... · T[~?.~r...~L.9. ........... ., 19..~., pursuant to which Building Permit No...~...~'.~ .............. dated ................. ~.~.~..~.1..~.~.~......?. ............ , 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 .............. ............................................... .................................................. This certificate is issued to ~.1~.:~...~.~1.~f~.~;.;~...1~l~'. ............................................................ (owner, lessee or tenant of the aforesaid building. FO]F~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREM SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 562 Z ] 9..'~...~.. ission is herj~by granted to: pursuant to application dated ................ .~ ....... ~..~,. ....... 19,.,'~,..~ and approved by the Building Inspector Fee $/ ...... ~ .............. ~C~ il;'r~g ~ctor ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~, N. Y. Examined ...... . .~..~/....'.Z...~... ....... /. ........ 19 ...... l. Approved ......................... ~..~ ............ 19...~...Permit No. '~ ~ ~'~ Disapproved a/c ............................................................... :~: ................ ............. ...................................... (Building inspector) 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 k. ept 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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: .................... Street and Number .....~.~..~:~.-....~ ........................................................................................... Municipality 2. State existing use and occupancy of premises and 'intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ...................... ..w....~./,,..~.:..'~..~ ....... r .................................................................... .... Nature of work (check which applicable): New Buildi~ Repair .................... Removal .................... Demolition... Estimated Cost .......... I..~....~ ............................... F If dwelling, number of dwelling units ............. / ............... ~g .................... ddition .................... Alteration ................. Other Work (Describe) .................... (to be paid on filing this application) ..Number of dwelling units on each floor...../(.. .................... If garage, number of cars .............. ]. .......................................................................................................................... If business, commercial or mixed occupancy, speci' nature and extent of each type of use .............................. 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 .............................. Jmber of Stories ........./. ...................... '4P ~ / ........ .~...G. ............. Depth ............................ Dimensions of entire new construction: Front .......................... Rear Height ! ~ / Number of Stories Size of lot: Front ....... ./..~..! ........ Rear 10. 11. 12. 13. Dc~te of Purchase ........................................................ h Zone or use district in which premises are situated. Does proposed construction violate any zoning law, Name of Owner of premises...~.:...%.'.~...~..~.:.~.'.Q, Nome of Archltect.....~ ............................... Name of Contractor.~.....~:.~.~, PLOT Db Locate dearly and distinctly all buildings, whether exi property lines. Give street and block numbers or descriptio~ whether interior or corner lot. STATE OF NEW,,-YO~,J~,A ~ ) S S COUNTY OF...~.'.~.....) ' .......................... L.trJ..~.~ ....... , ................................................. (Name of i~idual ~p/J~on) above named. He is the ............. : .... ~.~.~.~ ........~..~...~ (Contrac of said owner or owners, and is duly authorized to perform this application; that all statements contained in this appli( and that the work will be performed in the manner set Sworn to before me this ~ ,,_ ~b',t; ..L of ........... ':'.? Nota~ Public, ame of Former Owner ........................................................ ~rdinance or regulation? ~ ~ddress ....~....c~...~..~.Phone NO ..................... ~ddress ~..."7. .............. Phone NO ..................... ~ddress .....~...~..~./.~.~...~r.. ........... Phone NO.~r%.).:;.~...R....~.O kGRAM ¢ing or proposed, and indicate all set-back dimensions from according to deed, and show street names and indicate eing duly sworn, deposes and says that he is the applicant ....................................... :or, agent, corporate officer, etc.) or have performed the said work and to make and file arian are true to the best of his knowledge and belief; in the application filed therewith. ' ', ~'o;,,; ,,~ (Signature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×amined ......... Approved ........................................ 19.: ...... Permit No ............................... Disapproved a/c .............................................................................................. Application No. ~"'~ 2-~ APPLICATION FOR BUILDING PERMIT Dote ....... ? ............................................. ] 9..~. 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 l~ept 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 Sou'thoid, Suffolk County, New York, and other opplicable 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. .... (::~.~...~..,.~. :.~.....~'?.'.~<I:....~.~,Z...~:.~:?:~, .................... (Signature of applicant, or name, if a corporation) ................ '....',. L+:'.....; ~. :: ~*~.&.~ ~ ................................................... (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ses..,,~t.~ :~,..,,N,x;~..q ...... ~ ............... ~ ......................................................... 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: .................... Street and Number .............. 'z:,,: ....... : ....... :: ................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy bf proposed construction: a. Existing use and occupancy ..................................................................................................................................... J,") vV L~' t .' .. ", b. Intended use and occupancy ................... : .......... :'...~.~..: ....... ~,~/. .............................................................................. 3. Nature of work (check which applicable): New Building ............. Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... .'..~...?~L~...~:.":~ ............................... Fee ..J...~. ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ./ .................. Number of dwelling units on each floor....L ..................... 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 ............................. :Nun)ber of Stories ................................ · · S ~_~ 8, Dimensions o~ entire new constructmn, Front ............................ R~r ............................ Depth ............................ Height ............................ Number of Stories ............................ ' / ~ ~ ' e 9. Size o~ lot. Front ............................ Rear ............................ D pth ............................. 10. D~te o~ Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zone or use district in which premises ere situated ........................ ~..~...,.¢.~t-5;?..~ ................................................... 12. Does proposed construction violate any zoning law, ordinance or reguletion~ ............................................ 13. Nome of Owner of premises..., .............................. ~..Add[ess ...~. ....................................... Phone NO ..................... Name of Architect ...... ~ ............................................... Address .~ ......... ~. ............................ Phone NO ..................... Name o~ Confroctor ..................... ~ ............................ Address ............................................ rhone ~ ..................... 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 end indicate whether interior or corner lot. STATE OF NE~-YO)I~K,[J~ ) S S COUNTY OF ..~..~.~....~:.:...,.) ' ,'C, .f t , .v' ..... .~7~ ...... ~..'[.[~)..['(~. ........................................................ being duly sworn, deposes ond s~ys thef he is the opplicont (Name of i~idual ~ing application) . (Contractor, agent, corporate off'er, et~ o~ said owner or owners, and is duty authorized to perform or have performed the said work 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 forth in the application filed therewith· Sworn to bef~e me th~s ,, '~ ffor~r, ~ ......... ?" '~:~'"' ' ' "'5' ' ........ ~ Z.. day of ~ ................ ~ .... '19., , . ..z,, (S,gnature of apphcant) Nota~ PuNic, ..~..1~~ ....... Coanty' "~ :% ~4 6~ ~ ~,-. -~ ,