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Home My WebLink About584-zFORM NO. 4 TOWN O~: SOUTHOLD BUILDING ~DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~..A~ .............. Dote ............. Ee_'~t, em~:~z-. · · ...~,~ ................. 19~9 .... TH~S CERTIFIES that the building Iocoted ot.~./~,...~'..~el .........................................Stree~t Map No. ~ ............... Block No ........ ~ .......... Lot No..~, .......~t~}~e~ej.....~;~., ...................... conforms substantially to the App[icatlon for Building Permit heretofore filed in this office doted ..................... ,~.eb~'~......~.~ .......... , 19.~.~'...., pursuant to which Building Permit No ...... ~..~f~l~ ............ dated ............. ~.ebt~e.z,¥......~5 ................. , 1 ~9......, was issued, and conforms to all of the requirements of the applicable provislons of the law. The occupancy for which this certificate is issued is .............. ................. ~,~.~a.t,e.. ~e.. £e,,~y.. ~L~e],~L~,~g ........................................................................................ This certificate is issued to .~'~,t~..&..He~.~....P.c~]~e~. ....... ~....~.~. ............................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS P'ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 584 Z Dote ........... Fe b.~ ~'.y ....... 2~. ................. 19..~9.. Permission is hereby granted to: Fr a'~"e"H~l~'n'""P~l'eeki ................................ ....... H~.tn..Rea ~} ................................................... ............... (~u ~c ~h c~g u.e.....N.; .y.; .............................. to ·.. · ~U~.ld. · .n~w...D~,~e_.l.,.l. ir~ ............................................................................................................ at premises located at ....?;./.~.....~}r...Beed. ......................................................................................... .............................................................. (~ut;e.h e.~t~a.i..... ~ ;.F; ............................................................. pursuant to application dated ....................... ~It~.htla~.~,.,2.~. ................ 19..~.., and approved by the Building Inspector Fee $..lO.o.O0......pf~ id Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. · £, .~ ~ ~' Examined ........ ]... ............................ 19 ....... J' Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ........ ~...~ ........ ~ .......... ....~. .............. ...... ...... ......... r ................ Application No ........ ~..~...~[ .......... APPLICATION FOR BUILDING PERMIT Date ............................................................ 19.....~. ..... INSTRUCTIONS o. This application must be campier, ely 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 port 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 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 p art for any purpose whatever until .a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the issuanc,e 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 appiioabie laws, ordinances and regulations. ,/~ (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 premises.......~.-~-~.......~..-~:....-.Z~.~..~ ....... ?'"'~-~: ....................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be don~e. Map I~o: ............................ .~ .............. Lot No: .................... Street and Number ...~..J..~ ....... .~....~......~I~Z~-~-.....~......~'~~~ .............................. / Municipality State existing use and occupancy of pr,emises and intended use and occupancy of proposed const uction: o. Existing use and occupancy ................................ ; ................................................................................ b. Intended use and occupancy ~ 3. Nature of work (check which applicable): New Building ........ /.L ........ Addition .................... Alteration .................... Repair ................. ,~,Remoyal .................... Demolition .................. ~,,Other Work (Describe) .................... 4. Estimated Cost ............ ~-';/...~..,...~.~.~. ........................... Fee ............. '~/' '--/.4~ ......................................................................... . ! (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ]. ................. Number of dweJling 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 ........... .~. .............. Depth ....... Height ............................ Number of Stories 9. Size of lot: Front ..../..~..~.../. ......... Rear ...... ~...~.~/./.. ....... Depth ..../.. '"~....~....C'~... /; 10. Date of Purchase ~...~../...~'~....~...Name of For~j' Owner .~....~...~....C~ 1 1. Zone or use district in which premises are situated .................... ./..Z .................................... ~ ................................. 12. Does proposed construction violate any 7,,on_ing Law, ordinance or regulation? ............ ~ .............................. 13. Name of Owner of premis~~...~.Address~ ............................................ Phone NO Name of Architect .........,~4..,~c,~r.,~e~./. ....................... Address ..................... .~ ........ , .......... Phone NO ..................... Name of Contractor.~..~'~~.Address ........ ~..~.....Phono NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate oil 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. s'rA'r OF ' ) s s COUNTY OF ..~L....) ' ........ ....................................... being duly sworn, deposes .and says that he is the applicant (Name of individual signing application) above named. He is the ................................... ~ .................................................................................... (Contractor, agent, corporate officer, etc.) of salcl owner or owners, and is duly authorized to perform or have performed the said work and to make and file this app icatlon; 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 fJ ed therewith. Sworn to before me this ~, _ /t~. ~471~. ~_ TOWN OF SOUT~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT"OLD , N. (Buildin0 Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT Dote ............................................................ 1 c) ............ 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 progress of the work. e. No building shall be occupied or used in whole or in part 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 issuance of o 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 regulations. ,:'L (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 v ................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be dope. MopNo: ............................................Lot No: .................... Street and Number ...b.,...).:-~~. ....... ~.;r..~..C:.~'.~........~:~:.~..-~-~:.~- ............ ,~.,,.(..¢.L.~'~..~!,~.~...:~.,~ .............................. , (J Municipality .r/ State existing use and occupancy of pr. emises and intended use and occupancy at'proposed construction: -d >'4~,- ~..Lt -'~ c~'~ a. Existing use and occupancy ...............x...- ......... '.'..;.: ........ ~ ........ : ................................................................................ b. Intended use and occupancy ............. ~;,~Z~':(/.?..~..,~./,,..~..~.,:Z.¥,'./~. ............................................................................ 3. Nature of work (check which applicable): New Building...A. ............. Addition ....................Alteration .................... Repair ....................Removal .................... Demolition ................. ,.,Other Work (Describe) .................... 4. Estimated Cost ~// /.>[.,f ~ (~ O · 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 Depth Height ............................ Number of Stories ............................ ~ 9. S~ze of lot: Front ...., ........................ Rear ......~....,.,,., ........... Depth ..................... ~.. t/, 10. uate ot rurcnase ...:.:'...:.'.- ........... ............. :.f..: .............. mame ot ~orm~ uwner ...................... ~ .............................. 11. Zone or use district in which premises are situated ..................... .............................. ~.ff_... ............................ 12. Does proposed construction violgte any ~6jng I~w~ ordinance or regulation? .................................................... 13. Name of Owner of premises,.., ........ ;~ .............. :....; ....... Address ............................................ Phone NO ..................... Name of Architect ............ ':~L,...:..~¢"-:..C~.,.~ ...................... Address .~ ....... ~ ............... ,..~...~ ......... Phone NO ..................... Nome of Contractor .... ............................................ Address ........... ::.;..:..:.~:......~ ........... Phone NO ..................... PLOT DIAG~A~ Lacate clearly and distinctly all buildings, whether existing or p~ovosed, 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 nterior or corner lot. STATE OF NE~Ii~I[~.E.,/I: ) S S COUNTY OF ...~..(~//.../...:l~l...) 'ir') ~. _ , . ............................ ..................................................................... ~emg duly sworn, deposes ,and ~ay~ that ~ is the (Nome of individual signing applica~, ~_ above named. He is the ............................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hqve performed the said work and to make and file this application; that all statements contained in this application are true fo the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicQtion filed therewith. Sworn to b~f~e me thisr .~ ~_~/~ ~..~OW~ dav of .~...:....~.......:~...., 19..~'i~1~'~ Y~ (S gnature of app ca~) ...................... ~ ~ ...... ~ ' A~ ~ ~vo. ~ .~ ~7~ ~ /] ~ //