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Home My WebLink About568-zFORM NO. 4 TOWN OF SOUTHOLD BLHLDING D£PARTMENT TOWN CLERK'S OFFICE SO.UTHO.LD, N. Y, CIERT~FICATF~ OF OCCUPANCY THIS CERTIFIES that the building located Map No....?.?.~ .............. Block No ........ .~.~...*. ......... Lot No....?.?..?. .......................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... .~.~tfl,~.~'...~!~ ........... , 1~......., pursuant to which Build,ng Permit No.:~...~'.~.~ ................. dated ................... ~.~[l~l,~...2!J'. .......... , 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 .............. ....................................... P.H ~1~ A.T~...O~-I~IL~..D~LL~G ........................................................ This certificate is issued to~.O.~....~.?...O..¥~....~...~..~..~....O..¥..~..??.. ...................................................................... (owner, lessee or tenant) of the eforesaid building. Home. ct M. FOI~,M 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? 568 Z Date ........ Permission is hereby granted to: E1 ] i ~..$3a~Ti-......~'g...-.~fot~n...B~e~ir~g ............... ....... R.~:v~erhee,~ ¥-.-I~.~ ~.~--. (.m~a... ~sLl~zta...Lu~b~r ) to ....... P;~iTd' -~¥ "~d'T~ ~'cn' "o~ · · ~'n "'exi'$ t lng · ' ~t'l-ing .................................................. at promises located at '"'~';/"~"'Tj:~:~'~.:~'"??C:fL~f;:'"~'~r~: ....................................................................... ......................................................... Gt~-~C ~'~ ~:ue'~' · --- · ~ ,. ~.~ ................................................................. pursuant to application dated ...............~8,~.....~ .......................19..~., ond approved by the Building Inspector Fee $.~...QQ ............. ding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exa mined.~~.....~......~...... 19..~..~ 'k 19 q Perm.t' No Approved~ ............................... ........ ............................... Disapproved a/c .............................................................................................. ........... ....................... (Building Inspector) Application No. ~'~ ~ APPLICATION FOR BUILDING PERMI'~'~ ~,~.~ ................... INSTRUCTIONS a. This application must be complet, ely filled in by typewriter or in ink ond 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 layo~t~t 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 Certificat, e of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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~/~al~:t r~e§ulol ~..~.s.....~..~..~ (~i~noture of c ~t, aP)name, if a corpo[~ion) ......... Jdress of app icon, (J State whether applic, g~ 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 ..~./~.~....~~..~.~."~...~:::....~.....~'(~......~...X .......... .~...~....~.....~.~.. ..~.... ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ,.J~.~~..'l% ~J' ,,~ /1 ~ .~ ............................... '~' .................................. b. intended use and occupancy....~. ................... ~ ..................... '"'.....7~......~..~....~ ......... ' ......... 3. Nature of work (check which appllcable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost...../..~....O....O... ~ 4. Estimated ................................. Fee ~..~... ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ ~ ...... Number of dwelling units on each floor ............................ If ggrage, 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 .......... .~..~)....3~. ..... 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.. ......... Rear ............ ~ ........ Depth ..../..~ ................ Height ............................ Number of Stories ...~ ....... 9. Size of lot: Front ./...~..q ~' Rear //5'. ~/ Depth 10. Date of Purchase ........................................................ Name of Former Owner .... ., .................................................. ] ]. Zone or use district in which premises ore situoted ............... r ..................................................... 12. Does proposed construction violote ony zoning law, ordinance or regulotion? ................................................. [.. 13. Name of Owner of premise~..t~3. Address ............................................ Phone NO ..................... Name of Architect......~)fj6....: .~....~..~...~..AddressLa' ( I . ~') fl ~'/-'a ............................................ Phone NO ................... :. Name of Contractor..~.......-"~.: ............................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number r description acco/r,~in~g to deed, and show street names and indicate whether interior or ",~,~'~" ~' '~°'['/~O-~ h~ ~ ~P S 'A-rE OF- ) s s .............................. ~ ........... ~,~..,,~b~,~'..,,~ ........... being duty 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 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 are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applic~o filed therewit~ ~ _ Sworn to ~efore me this ~ ~ ~b~'~'~ '~0'un~ ~ ~ ~ ~ ~// ~ ~ ~pp~~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exammed..?/....~? ~ z' ,f~ Approved~; 19 Permit No Disapproved a/c.~.;:;~ ......... ~. ..................................................................... Application No ............................. (Building Inspector) APPLICATION FOR BU~LDING PERM~T~ Date....~)...~.'~...'~....~......~.....~...~ ................... 19..~...~. .... 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 .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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances and r, egulations. (~/gnature of appli~'c~Dt, or name, if a corpocqtion). ......... L:.p.L ......... (Addrbss of applicant) (/ State whether applic/a~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ..................... .::; ...... :...: ........ : ................................................................. Name of owner of premises.....~:;('~ ............ f!..~...:.~.~c:~..~,..,:~....,~ ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wbch proposed ~ork wdl be done~ Map,No: .......................................... .~ Lot~No: .................... Street and Number ....... ~..~.~...'../../.~...:.~.r.. ::. '...../b~...ct...~ -. ........... ::Z ~¥.-~....~...~.. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... : .... ~,,..,..f~ .................... ~ .......... ';4 .................................. b. Intended use and occupancy .........................t...~. ........................ '.....~.-......~..,71!..!:~.~.~,,~ .................. 3. Nature of work (check which applica'ble): New Building .................... Addition ~ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost...../.~..~...O. 4. Estimated .......................................... 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, Jf any: Front ............. ~'..~...:~ Rear ........... ~.~').--~...... Depth .....~,j...~ ............ Height ............................ Number of Stories ..~zr:~¢,,~.-,..,, .......................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ,~g,,.O ......... Rear ............ t~.¢~ ....... Depth ...~..'~. ................ Height ............................ Number of Stories ....O~..~n,,~,,~ ....... 9. Size of lot: Front Rear ........... Depth 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] I. Zone or use district in which premises ore s~tuated ..................................................................... ]2. Does proposed construction violote any zoning law, ordinonce or regulotion? .................................................... 13. Name of Owner of premise ....-,.,.-,/'~'~.~...,~:... · ~ .... -~.Address ............................................ Phone NO ..................... Name of Arch.tect...~..~.>:!.fl.:..~.~4..'.V.~:?:'..:...~...~.....Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property nes Gve street and block number~o~-~descri~tion acccl~ii~cl to deed, and show street names and indicate whether interior or--eer~---~ STATE OF NEW--Y(~./~.,/),//__ ) o S COUN- o, MI1 "~:Z~ be n duly sworn, deposes and says that he is the applicant ............................... ~.T .................... ~..Z~ .................... g (Name of individual signin~pplication) ~ above named. He is t~e ..................... ~.~:;......~: ........................................................................................................................ (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 th s appHcatlon; that all statements contained Jn this ap~H~ation are true to the best of his know~edge and belief; and that the work w I be performed n the manner ~r~in~.applic~iled t~e~wi~ Sworn to fore me th s [ ~ ~1 I ~ t ~. . day of '.,] ~ ~ ~:~ ~.', "~ ~ o (S~gn~ture of apphc~nt) . . ' L. , ~l~rch ~ . Notaw Publ c~..~~..~ounty