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Home My WebLink About1092-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ ..~.../~.~..~ ...... Date ..................... ~.aJtU//~...~-~L .......... , ] 9..~1. THIS CERTIFIES that the building located at ..~.~,~...~...~~ Street Map No.~.W ................Block No ........ .~g.~ ....... Lot No ................... ~ ........................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~..~.~ ...................................... 19..~0. pursuant to which Building Permit No. ~..~2.. dated ...~,~...~. .................................. , 19....~0 was issued, and conforms to ail of the requirements of the applicable provisions of the I~. The occupancy for which this certificate is issued is .......... ............. ~...~..~X..~ ................................................................................. This certificate is issued to ............. ~..~... ~ ............................................................ ~owner, J~ssee or tenant) of the a.foresaid building. FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPAI~TI~ENT 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? 1092' Z Permission is h~reby grgn~'ed to: ~)oz~e~l~l:... ~es~;o,~ ............... i .................................... ..... i......Z~;r~..~,.~..$,e,~e .............................. c~t premises located at, .~b:~.~;...~O~d...O~.-.~[8~...V~e~.-.~- ................. '.,;..,~. ....................... : ..... pursuant,to ~application )ated ..... · ..: ...................... ~...:.,~....~ ........ , ....... 19~0.., aBd opproyed by the FOI~M NO. ! Approved *'t , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT,O,D, .. / 19 ........ Permit No. Disapproved a/c ............~~.~~ .............. ..................... (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, 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 Bu.ilding Inspector will issue o 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 all applicable laws, ordinances and regulations. (Address of applicant) 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) Location of land on wh ch proposed work w II be/done. Mop, No: Street and Number ...~ ................................................................................................ Municipality 2. State existing use and occupancy of prem~x~intended u~se and occupancy of proposed construction: o. Existing use and occupancy ............ .~....~.~....~ .................................................................. b. Intended use and occupancy ...................... /./.~ ..................................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Rpmoval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........z..,,.~.,...~. ....................................... 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 pature and extent of each type of use ................................ Height ...... ~.2..~.~.'~. ..... Number of Stories ......... ~ .................................................................................................. Dimensions of same structure with alterations or additions: Front ........ ~..~.;....~.~.~... Rear ........ A~....~.~....'.... Depth ~ Height ........... ~.2..~.~.,~'. ..... Number of Stories ) . 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ................................ ]1. Zone ~r use distric~ in w~ich p~emises are si~umed .................. ~ .............................................................................. ~2. Does proposed constr~ction viable a~y zo~i~ IQw, ordinance or regulation? ........ ~ ....................................... Name of Architect ..................... ~..., ......................... Address .......................................... ~b~e 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 :orner lot. STATE OF NEW,~'O. RJ~.,~/./) S S ........... ~~...~~.~ ......... bein~ duly sworn, deposes and soys thor he is the opplicont obove nomod. Ho is the ...... ~~~ ............................................................................................... (Controctor, oOenh corporote officer, etc.) of s~id owner or owners, ond is duly authorixed to per~orm or h~ve performed the s~id work ~nd to m~ke ond file this oppllc~tion~ thor oH statements contained in this ~p~lic~tion ore trua to the best of his knowledoe ond ond thor the work will be performod in tho monnor set {orth in the applicotion filed th~rowith. th s ~ota ~tTff T. ~n~N , Sworn to before me ' ~ ublic, State of Now ,/ / ~ ............ ...... ............... ............. FOI~M NO. 1 Examined .................................... 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ................................. APPLICATION FOR BUILDING PERMIT Date ........................................................ , !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 ocation. 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 shah 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. - (Signature of appli~.~, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) 1. -~lf'applicant,~. is a corporate, signature of duly authorized officer. ,4/,- ,/~/~//-/t /~/(,.~/,x~/4, . Location of land on which proposed work will be c~one~. Mop No: .....~ .................................... Lot No: .................... Municipality 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 ................................................................................................................................. 3. Nature of work (check which applicable): New B Ildfn Addit ~" AI ti u ~ .................... ion .................... tera on.,,,,, .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cast ........... ~'.....~.. ......................................... 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 ...... .,~..~..i,.~..~] ...... Depth ....... ..~-.....~....~..3...././~...".. Height ......... ~...~..(..~.~.'....* ' Number of Stories ................ / ........................................................................................... Dimensions of same structure with alterations or additions: Front ~'~ 2~ ~ ~ '~ ., ,.-~.~ ~t ................................ 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 ...... ~.,q..' ........... ',, Depth ........ ~.,T.~_,,~,~,,....,.~ ]0. Date of Purchase ....... ~../~.~.Y.,~.,.,,./.~..~t~.. ............. Nome of Former Owner ,, ..~./~. ,~..,.~.,..,,,~......~..~..' ............. . , I(/t ~ 11. Zone or use district in which premises are siruatea .......... ~ ..................................................................................... 12. Does proposed construct on v o ate any zon ng aw, ordnance or regu at on? ...... . .~....~.. ........................................ 13. Name of Owner of premises..~.~.,~,~.....~..//./7~.~S...~....~'....Address ./~..~...~./.~.~...~..../~..C.~.,..~..9..°.[l~o~neT~l~ .................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Cant racto r ~.I/~r/~....../~.~.~..~....~.. ........Add ress 4/~.//-~ .~W.~.~4~..~.......~../.?...~/~h~o~n e~'~)~ .................... 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 corne.r lot. STATE S.S. COUNTY ...... being duly sworn, deposes and says that he is the applicant (Name of individual s. lgning application) (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 Sworn to before me this .ota~ public, State of New (Signature of applicant)