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Home My WebLink About1047-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....2L.].~.9~ .......... Dote .......... De. ceml~.ez1......3.0. ................. , 19...6..3. THIS CERTIFIES that the building Iocoted at ..,~/~..]~.].O~....]~eC~,.~D.~. ................ Street Map No...~¢.,~4~', ............ Block No....~'~1C ........... Lot No. ~,~ ....... }'J~'Lt, t.~'QO]~,~...~.,.~', .................. conforms substantiolly to the Applicotion for Building Permit heretofore filed in this office dated ................................ ~p~-..2.~. ................... , 19.6~... pursuant to which Building Permit No..~...~...~..?. dated .............................. /L~Q~.....2~....., 19..~.0.., was issued, and conforms to all of the requirements of the applicabie provisions of the law. The occupancy for which this certificate is }ssued is ........ ........... pv.~.V~t~e., ene.,.~m.~.l~,..d.~el, lin~ ...................................................................................... The certificate is issued to ~.O}~'~ ~: i~,l~l, ae }~:~O10~.~.~. ................ Q.~/~.~.J~ .......... (owner, lessee or tenant) of the aforesaid building. TOWN OF 50UTHOLD I~UILDING DEFARTMENT 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? lo47 z Date ....................... A.}~I~-~,.], ·. ·..~ ............. 1760.. Permission is hereby granted to: ~oh~.. &.. ~r~ee..t~.oeh~.d .............................. ....... ......... ............... ~f~.~.~e~ ,.....~,.~,,. ........................... to ..~u~d...~..a~d~t~n...on..~..~s.~...d~.~,~ ....................................................... at premises located at .~.~.....~[]J~..~e~..~O~L.@:..L.,.[~,~.O.~[ ....................................... ....................................................... ~¢.~t$~uC~-.-.~,~., ................................................................... pursdant to application dated ...................................... ./~.~.~t....'.~.~....19.60% and approved by the Building Inspector Fee $.~,,.0.0 .............. ' · ~' Build~g Inspector I ' FOHM NO, I Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~.....Permit No....~..7~...J...O..~...~ ........... Disapproved a/c t~ ~ ~.~ ~. ~ ~.~ ........ .............. ~ ............... , ........... ~ ............... ;~ ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT 6,¢ Date ........... : ........................... , i 9...~..0. 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 Perrnit 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 issua.nce 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. ' "': !' , i ', , , ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ' . .......... Name of owner of premises ....................................................................... If opp{Jcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Location of land on which proposed wor~ will be done. Map No: ............................................ Lot No: .................... Street and Number .......... .~..~,~,~.L~-~...,.~O.~-~%.C. ZL....(!..~..(',(~. ...... ~!.~(~'~.~].~.~:.~.~. .......................................... Municipality State existing use and occupancy of premises an.d intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~...~,'~.fJL.~...v~.'.~.'~,(,~.0 ........................................................................................ b. Intended use and occupancy ........... '..q-..~./~,.~.~. ,,.~.~,L~, ...... ..~.%-.~.: i.....°;..~. ~: .............................................. U/' Alteration , . 3. Nature of work (check which applicable): New Building .................... Addition ...................................... Repair ................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... ~...g...L) .............................. 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. Jf business, commercial or mixed occupancy, specify nature and extentr of each type of ase ................................ 7. Dimensions of existing structures, if any: Front ....... .~...(~...i..J.a;¢..%. Rear .~jj)..~...i'. .............. Depth .....~..~. .................... Height ..... ~J...~..! .............. Number of Stories ............ ~'.,~ ...................................................................... Dimensions of same structure with alterations or additions: Front ....... /...~.. ................. Rear ....... Z..~.~ ................. Depth ......... .~'~.~./. .............. Height ........ /...~ ................... Number of Stories ........../.. .................... 8. Dimensions of entire new construction: Front ...... :'~'~ ................ Rear ..... "Z/~ .................. Depth ~ / Stories ........... ../. .................. Height ............ L.7. ........... Number of 11 Zone or use district in which premises ares tuated , ,~-...~.4./'/.~/¢/'~ 12. Does proposed construct on v o ate any zon ng aw, oral nonce or regu at on? .. Name of Architect ( ................................................... Address .......................................... Phone NO ..................... Name of Contractor ........... .'.: ................... 'f .................. 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 or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEV~ ~ ~K~/r ) S S COUNTY OF .t'~..;] .~'~...L~.~L ...... ) · ' ..................................... ~.c~..:~...~..~;...~.....9~...~,,..being duly sworn, deposes and says that he is the opplican~ ~Nome 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 hove 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 flied therewith. Sworn to before me this .............. . .':~.....-~.... day, f,. ,a ¢~"'"C ............ Notary Public, ...... .~...~.~.~z.,.~.~..-~. tm4~,~ ......... County (Signature of applicant) FORM NO. 1 Approved .................................... , TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ~...o. .... ,, ,Z/o.~..3 ............. 19 ........ Permit No ........... Application No...!...0....~!..,~. ................. .............. .......... ....................... (Building Inspector) ~ 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, relotions~hip to adjoining premisfs 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 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 oil applicable 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. C', I ) : Name of owaer of remises,.t~.,~. :~, ....C:~::~ .../..':~:£..~...~ ...................... If applicant is o corporate, signature of duly authorized ofticer. (Name and title of corporate officer) 1. Location of land on which proposed work wil( be done. Map No: ............................................Lot No: .................... Street and Number 1~4 /- ~ y /'~. ..... ~ /'~ ,:.~ Municipality State existing use and occupancy of premises end intended use and occupancy of proposed construction: ........... ~..~-.~4..:~L ......................................................................................... a. Existing use and occupancy ~ -~ b. Intended use and occuponcy .........................t.~ ................. '.~...,,-~'~,,~-....~.,~ ................................................................. 3. Nature of work (check which applicable): New Buildin¢ .................... Addition..,..~ ......... Alteration .................... Repair .............. 3'" Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ~.~ ............................................ 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 .......~.6 ................ :~ 6 Rear ............................ Depth ...IL.c? ....................... Height .......... I..7. ............. Number of Stories ...... (:~:'. .............................................................................................. Dimensions of same structure with alterations or additions: Front ........ :~...~ ................ Rear Depth .............. ~/.....~. .......... Height ,,.,.q,7, ........................ Number of Stories ../, ........................... 8. Dimensions of entire new construction: Front ... ,~..?, ................... Rear ......,~.....o. ................ Depth Height ............. L.g ........... Number of Stories ......./. ....................... 9. Size of lot: Front ....Z.~.q~.~...~..:.!.....,~,.J~ Rear ...... ~,....~..q.....~.~... Depth ..~.3..~..?..../..~..~¢.. .......... )0. Date of urchase ........................................................ Name of Former Owner ....... ~ .................. : ........................ ) 1. Zone or use district in which premises are s tuoted .~'~ ~ ~ ~ ~ 12, Does proposed construction via}ate any zoning Iow, ordinance or regulation? 13. Name of Owner of premises..Z~,'¢,.~..,../~......~:~.~.~......,Address .......................................... Phone NO ..................... Name of Architect ............ ~'t~..~m.......K'~:~.~..m'.~ ....... Address .......................................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly ali 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 and indicate whether interior or corner lot. COUNTY OF ~.%....) ' ' '¢ , ........................... d.,, ,wo,n, .h* i, ,he (Name of individual signing application) above named. He is t~e ........................... ~ .............................................................................................. (Controctor, agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work mhd to make mhd file this opplicotion; thor o~l statements contained in this application ore 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 before me this ~ ~ ~1~ ~ ,,~ .................. ~... day of ........ ~,~: ................... ~> ......~. ~ Notary Public, .............. .................. ~ ......... County (Signature of applicant)