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Home My WebLink About1002-zTOWN OF SOUTHOLD BUILDING DEPAP~TMENT TOWN CLERK'S OFFICE SOUTfiOLD~, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~Z~.*...~.~l,~.e...k't./~...~I,~i~..~,~,. ............. Street Map No ....................... Block No ....................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. M..~.~..~....~ .............. 19....6.~. pursuant to which E~uilding Permit No ...... .~....~..0..02 dated ..................... ...1~..~.~....~..~. ............ , 19......~..,Owas issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... FRI~AT~ ON~ ~?AMI~Y DW~ING This certificate is issued to ...... ~.~..~.~t....~ ....................... t,.., .............................. (owner, lessee or tenant) of the aforesaid building. ........ ......... ................ Building Inspecto~ / FoR~i NO. 2 TOW~ 'OF 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? 10o2 Z Dote ......................... k~a,~.. ~.]~ ............. 19....~..0. Permission is hereby granted to: ..~e.~ .e....~.... ~..... ~.~.e.~ .................................. ..~.~..~.$..o. ~....~.. ~.o.~ ........................... to ..lmll~l.ac~£~.~u..oa..~xis.~...o~e..~a,~Ll,~/'...,~ell J,~g ........................................... at premises l~ted at ..~.~...~..~/~..~.,~,...~.~..~...~...~.. pursuant to appl'ication dated ................................. ~...~.....' ....... 19..~.., and approved by ~he Building Inspector Fee $,~** .O.O..~a~L~. l~ia FOE~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ~.~.'~.?~ ./, 19.~. Approved ........ r~'~r...c.~...~., 19~..Permit No.....~.~..~.~>.~,~.. Disapproved o/c ..Z.:._~.~~~ .................. ~_ Application No .......... .~....c~.?.~j ~ APPLICATION FOR BUILDING PERMIT 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 drown 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 ava.liable 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 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. ......... .............................. (S~rrature of applicant, or name, if o corporation) State whether 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 ..,~,~..~,~..~......f .... ~.~ ................ / MuBicipolity -- State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~.~?.- - , .......... ~.; ......... ~ ..~ ........... r .... ........ b. Intended use and occupancy .................................................................................. (..~(..~..4/,.~....~._,-~/,?,?, .............. 3. Nature of work (check which applicable): New IBuilding .................... Addition ........ ~ ......Alteration .................... Repair .................... Removal .................... Demolition ......... i ........ Other Work (Describe) .................... 4. Estimated Cost ....... .".~'.~f~).~.: ....................................... 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. D,mens,ons of ex,st,rig structures, ,f any. Front....~.~..~- ................. Rear ............................ Depth ..... ~...~:.. ............... Height ............................ Number of Stories ...... ~ ................................................................................................... Dimensions of same structure with alterations or additions: Front .~...~: ........... Rear ....~.~.. ........ ,-~/~0/z-/. '2z_ ' Number of Stones' / Depth .......... ;../...'.~....~.. ..... Height ................................ ................................ 8. Dimensions of/entire new construction; Front ......... ./(...~.. ............. Rear ....... /....~... .............. Depth .......~....~. ............... Height ............................ Number of Stories ......... ~ ................... 9. Size of lot: Front ....... .~'...D.../~.. .......... Rear ...... ./J'...~._ .~..'. ......... Depth ......... L.~?....~...?. ..... , 10. Date of Purchase .~.'/.¢~.~ .]/<.~...~...O.'. ~..... Name of Former Owner z/ ? ' ...... ;;" il. Zone or use district In which premises are situated ............... ~.....~..,~...~/~ ........... ~....:.~.~/Z ........... .~:~:/:.~.~]....~.~... 12. Does proposed construction violate any zo, ni_ng, law~ ordinance or ?gulation? ...... ~'.~.L"~.~.........~/. ................................. 13. Name of Owner of premise~C,;~.:.~.d.~.'.~./.~.~.~.'./ZAddress ~.~;..~.;~.'.~...~rS~.~.(.;. Phone NO ..................... Nome of Architect ........................ (( ............... .'~ ......... Address .......................................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... property lines. Give street and block numbers or descripti ? according whethe~ intl~rior or corner lot. I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or. proposed, and indicate all set-back dimensions from to deed, and show street names and indicate -.[ STATE OF NEW~ORK ,; /2), S S COUNTY OF,-~.~.~.G'J~ ' ' (Name ~ individual signing application) above named. He is the ....... ~..~.4,~,.~£,¢',;7..;:~.~.~.','.zd, .~.~.,K4~;~..~.&~,. ......................................................................................... (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 application filed therewith. JUDITH T. BOKEN ~otary Pubhc, State of New York Sworn fo before me this t~o. 52-0344963 Suffolk C~unty 1-~/ 30, ' ........... ~ ~' .~/~ { //~' - ~Notary Pubhc, ~~..~Z..~.~ ....... ;'..~,,,y (Signature of applicant) FOI/~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............ 19.4'~J Approved ......... No. L Disapproved a/c ........................................................................................... ..................................... in .................................................. T.~i:: .......... ~.2~..~ ~ Application No .......... ./..~. ~..~ (Building ~nspector) J~'~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 ava,liable 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 Certifica:te of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issua,nce 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. ........... ~;r~:~:'.'.~ ?.~..~(:: f. :: ~ ............................. (Si~bture of applicant,, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ 'i ......................................................... .................................................................... Nome of owner of premises ,~.~¢,~r.r...4.'~.,¢.f~.' ;~% -~.~';: :-,: , :/.~..'2 ................................................... 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 done. Map No: ........................................... .. Lot No: ...... ~ .............. Street and Number ~.z`~(~`.~/.~:.~(~.~`..~.<//.'.~:.`/..~./.~.~.~.~.~.~::~/..~.~~.~z...~..:~:~_~~~~ .............. / Municipality ' State existing use and occupancy of premi.ses and intended use and occupancy of proposed construction: a. Existing use and occupancy ~.~t~,,,~'~...~f'.:/.,.~?4,4~4..~d'C.~'~.,~.'~, ................. : ....................... Intended useandoccupancy~' ', ,, (/ ,, ~ " ..(/~,-~., ~//~'J~,'~.~ 3. Nature of work (check which applicable): New Building .................... Addition ....... ..~.... ....... Alteration .................... Repair ....................~-,',._~Rem°val .................... Demolition ........... "~";5" Other Work (Describe) .................... (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 ................................ Height ............................ Number of Stories ...... L.. ................................................................................................... Dimensions of same structure with alterations or additions: Front ° z Height' Number of Stones' Depth 8. Dimensions/of entire new construction: Front ........ ./..~ .......... ,.. Rear ...... ../..~. ............... Depth ..... ../.../~' ............... Height ............................ Number of Stories ......... L. .................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~.~.~ ........................................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM I.ocote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether int ~'rior or corner lot. STATE OF NEW );CORK /) couNtY ' .... ~.,, deposes and says that he is the applicant ..................... /.... ..................... being duly sworn, (Name ~ individual signing apphcahon) . 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 (~pplication; ~hat al 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. ...... ~ ... day of .............. Notary Public,