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Home My WebLink About1100-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUT~IOLD, N. Y, CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located a~ Cert.~l~.al..3D~,Vt3 ................................... Street Ca~tKidd Map No ....................... Block No....~ ...........Lot No...1~ ................M~i~mk~......}~...g~ .......... (,onforms substantially to the Application for Building Permit heretofore filed in [his office da~ed .......................... ~.._..~.., 19..~Q pursuant to which Bt~ilding Permit No. ~ .~[.00 ........ ~lated .................. .~e....6 .......... 19...~0, was issued, and conforms to ail of the requ~remcnts of the appXicable provisions of the law. The occupancy for which this certificate is issued is ............ ..................................................................................... 'Phis certiflcale is issued toG.~%~dB..&..~..~Pg~g~x''&''I~O~,],io'''Gowo~1 .................. of the aforesaid building, DUll (lnlg inspector \ FOI~M NO. 2 TOWN OF SOOTHOLD 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) 1100' Z Dote .............................. ~.~.e......6 ........... 19...6~ Permission is hereby granted to: Stanley Se~t~ .... ~(~.... Z~h ..~o~er~ ....................... .............. ............................ to.. :. ]~xO, l~ ..a/a.. ~d~JL~on ..on.. ~,x~ .,e:r~.~g...~te~.z~g ..................................................... at premises I~ated at .~a~..~..&..~..~.....~t.~..~...ge.~..~..~...~Z~ ....... .................................................... ~$~.....~,.~, ...................................................................... pursuant to applicatio~ dated ............................... ~e..-..~ ................ 19.~0.., and approved by the Building Inspector Fee $...~.~.~.... ,~,... cash Buildfhg Inspector FORM NO. 1 K' E TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~ ...... : .............. 19 ........ k? ApproYed ........................................ 19 ........ Permit No ............................... Disapproved a/c ........~~...... ~____~___ ................. i .................... - 'g p ................................. Application No ......./.!..~..,0. ........... A PLIC*TIO. FOR UmLDI. P R IT Date ...................... 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 Certificafe of Occupancy shah have been granted by the Building Inspector. APPLICATION IS 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ............. .~.~.L..G~.....~...~..-..~..~..~..~..~...T..J ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work w. II be done. M~ap N_i.,4.....~. ........................... o No: .../. ........ ( ...... Street and Number ..,~....~....~.......(~.....~ ....... .. .~.. . :. ..( ......................................................................... Municipality 2. State existing use and occupancy of pr,emises a!3d intended u~ and occupancy of proposed construction: property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ....... ..~.....~......Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...,...~.~.~..O...?...~. ........................................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling un[ts ............ ~ ....... 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 some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ]..Jm ........... Rear ............ ./...~ ......... Depth ....~...~,. ................. Height ............................ Number of Stories ..... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. ~ ............................................................................. 12. Does proposed construction violate an,,, zonina law, ordinance or regula]'ion? .................................................... 13. Name of Owner of premises.C~.%C.c'm'...~....%......~...Address ....... :,~....'~..'¥...~ .......... Phone NO ..................... Name of Architect ........................................................ Address ......................................... Phone NO ..................... Name of Controctor...~¢...~A...' ............................. Address .......... '..~...~/..~. ........... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate STATE OF NE'v~YOJ~I~,,~ ) S S COUNTY OF ..~..~.~...) ' ........................~ -, . . , ~......~.....~ ....... ~..~..~ ...... being duly sworn, deposes and says that he is the applicant (Name of individual signinf/ app/~a~dn!~--j~ / above named. He is the ............................... \=.~.k..~..o:.....~'..k~ ....................................................................................... (Contractor, agent, coqborate officer, etc.) of sold 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 this 'x~ ,. /, ~otary public, State of New York Sworn to before me ' U (.~No 52-034~963, Suffo[ ou · ..................... ~... dov of ............. ,~...'A....~.....~.. .......... 19 ............ . . . . I}~c~,~Qr/ature ~f opp[Icant) ~.-~ -- ~,-~- ~. ~ .,"' ,,/ ( /_/ ~ /~ ~ommisaten ~ires ~a~,c~/ out ~a~ Notary Public, ...~.4~.(.((6 ~.~~T,...C~...~f,....~.....C¢~, ,t'y'.c¢~, ,t~ - FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S' OFFICE SOUTHOLD, N. Y. Examined .......... ~.j .......................... 19 ........ L/ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ........~.....~:~.~ :..x~z~. · ·. ~..~xC/. · · .~t..: .~-~ ........... ..~-~ .......................... ............ i.,; ................................. Application No ............................. 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ~,rem.ses ................................... ~ ....... j~ .................................................................................................. 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. ~MaD No:,,:.!..U.":¥.)R??.:../.~.~.i.r..~'r.'./.....(.~.~M.. Lot No' Street and Number ,,~*-,~!. ...... ' ,~ , ~ Municipality 2. State existing use and occupancy of premises a~ intended use and occupancy of proposed construction: a. ~xisting use aha occup y ........................... ~..:~...,;::'z%; .............. z.....:q; ....... :~. ..................................................... b. Intended use and occupancy .................................................................................... ~.......~ ............. ~, .................... · A itio ~ ~ 3. Noture of work (check which opplicable)~ New Building .................... dd n .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost........~j.O...g...~. ........................................ 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 ............ J...~ ........... Rear ............. ~.....~. ......... Depth .....,/..~ ................. Height ............................ Number of Stories ...... ..~....~ ........ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. ,2~ ............................................................................. 12. Does proposed construction ,4~at.~jan¥ ff-oni,n~ law, ordinance ~Aregu~-, ,~z .................................................. 13, Nome of Owner of prem'ses..."~. :,.,L.....'. ....................... Address ............................................ Phone NO ..................... Nome of Architect ........~ ........ ! ................................... Address ........... Cb*.. ,. ~'..fi ........... 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 lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~D~ ~¢~ ) S S COUNTY OF ........ ./.'.~..'.~.,,~..) ,~ ' ~-' ~ ~3'? ~ .......~ '- .(~ ................. being duly sworn, deposes and says that he is the applicant ................................. .'"'V'[ .......... ~'"'; ........... ]'"";' (Name of ,nd,v,dual s,gn,ng/app~~~- 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 know[edge and belief;' and that the work will be performed in the manner set forth in the applicati~ filed therew)th. Sworn to befor~ me this ~'~ ~ ~ _ ~ /. ................. ~/ ~ ~ / ~ ~ ~ ~otarv Pul~hc, Stato of New York ....... I ...... ~ ~u'~ ...... ~ ......... ~''''"~glBJJh~%lOJl ~X~I[~ ~8[~Jl 30t 19 ~ /