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Home My WebLink About1596-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .W./.8.....C. amp..Ninedle..iR~:~.d. ............. Street conforms substantially to the Application for Building Permit heretofore tiled in this office dated dated .................. g.O.~;g.b.ez.....2~. ........ , 19.(::~[.., was issued, and conform~ t9 all of the requirements of the applicable provisions of the law. The occupancy for which this c~rtificate is issued,is ...... 't.,.. (owner, lessee or tenant) of the aforesaid building. H.D. approval by Majkowski Building Inspector ( TOWN OF SOuTNOLD 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.o 1596, Z Date ................... ~(t.~.Q'b~ ....... 26 .......... 19..6~L. Permission is hereby granted to: .,T.~... Z,... K~h ................................................ ........ 9.~;m~..~:~ime. f~..~!~.~/:~i ............................... .............. ff~&.t..i.t...u.~. ............................................. to ... ~..~.c.L .~q.p~f...~... ~ .~ ~-~.;k,l. y....d.¥.~,]~,~g ................................................................................... at premises located at ~{/~D.....~t~tt0..t~i~.e~.].D,..P~o~ ....................................................................... ........................................................ a~.t i.tn~tc ..................................................................................... pursuant to appticaHon dated ............................. C~¢~t)..r.~,~:.....2~. ........ 19~]L..., and approved by the Building Inspector FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................/.. ...... Application No ..... ~ ..:.~..:/..f~ ......... 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 application. 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been gr.onted 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 demolitio[% as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations· ........ ..................................... ~(~'~Signofure of j~)iiconf, or name, if a corporation) . . d .P. . . . z . z,z . d_z . .c- ., . . /'_Z//j. fZ/. .f. ? (Address of applic~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ......... ................................................................................................................... Name of owner of premises ....... .~....~?..~...~.....~.......~..i.......~.....~....~:-.../-..~.. ............................................................................. If applicant is a corporate, signature ot: 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 ~ ~... !... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'~f:?~..J.~-....(%....;~:~.~./..9'2..~.. ~..~z;.~.../..~.:~.~...~ ~ ................................... b. I ntended use a nd occupancy .. · '.P....~...~.../.¢~. ~...~..,...~.~ ~....T........}'~..~..'...~.~. ~....z~,.../.,,,',~,,,.,,~,,, .......................... Nature of work (check which applicable): New Building ..... ~N,' .....Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ....... ~...../x,~,~y..~...~..~. ........................ Fee ..... .~......Z.~..r.. ,~_..~.. .......................................................... (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.......~.. ................... Rear ....... ~ ........... Depth ,~.Z~ / Height/~/~£~...../~. ........Number of Stories ................. ~. .............. 9. Sizeoflot: Front ........./.....~... ............. ~. e '~.! ~' ~,~(J / Rear ........ .~..~ ............. Depth .................................... , 10. Date of Purchase ........ {..4~.. ..~. ................... Name of Former Owner .,..~....~:'..?..~.....~.....~..~...../.~.~...~../.~. 11. Zone or use district in which premises ore situated ........ ~...~..~.~.~..~z..~.....~..~.././~....Z~.. ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ..~...~. .................................... 13. Name of Owner of premises .~/~.,S.,.../..'~'.~'.~..I.~. .......... Address ~J~/~/?/~,//zfJ~'~Z~r.~,f/~/.~..~. Phone No.~./~..~..-..~..~.~. ~' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor J/~/?.$~.~C/2/,,~'~V4),~/.'...~h~ .......Address ~..~./~.-~.~)S .~.~. ............. Phone No.~...~.Z.~.~....~..~...~ 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 numbers or description according to and show street names and indicate whether interior or corner lot. STATE OF NEW~YO, R~, ,,~ ) S S COUNWn ...... ,,;~.'.~.g4~..'~?'....~,.~/. ....... .~ ...................... being duly sworn, deposes and soys that he is the applicant ~ -- (Name of ~dividual s~gning application) above n~med. 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 opplication; that oil statements contained in t~is application are true to the best of his knowledge and belief; and that the work will be performed in the m~nner set forth in the application filed therewith. Sworn to before me thls ........ '~:~* ....... day of ....~ ............. ff ....... ~[L]D~[[.' ~ (~ Z/ / ~ __ otary rubhc, State o Nev. Mevk.,..~'~2~,.~.,~ .................... sid~n~ m Suffolk C 52 7 Notary Publ,c ....... ~ · 4~0 (S~attature of a hcant) FOP~I NO, 1 . ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ........ Approved ..................... .~..L. ............... , 19,.~/.....Permit No ....... : ....................... (Building Insp/[etor) 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 o detailed description of layout of property must be drawn on the diagram which is part of this application. 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 pa rt 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. ........... .................................. U~ignoture of o~e~'icont, or nome, 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 premises ,~ ..................... ~ .................................................................................... 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 ..4~.'z~..//.].~...../~./..z~. ~....~..~.~. ~.~..~./~../. //~.~. ~..../..~.~.~...C.~...,...~.r....~ .. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exlst ing use a nd acc up a ncy .. · .,~. ~..~../...~.- .~. -.. · ~7~)./-'-'-'-'-'-'-'-'~..~......~..~.'. ~.../..~.- .~ ...~.....~..~....~. · ............................. b. Intended use and occupancy ..................... 3. Nature of work (check which applicable): New Building ....,..~.. ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... 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 ........... /.i ............................................................................................................................... 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 ........ ./.~...~. ................ Rear ....... .~...~. .............. Depth ...... .'.~...~.. ....... 10. Date of Purchase .............. ./.c~./C~...~....,~..,~...~.,.....Name of Former Owner 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~.....~. ..................................... Name of Architect ...................................................... 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 black numbers or description according to deed and show street names and indicate whether interior or corner lot. COUNTY O~;/~.ff ~. ................ ) ' · ........ ~..~..~~...,~ ........................ being duly sworn, deposes and says that he is the applicant ~'~//~'~N,ame of ir~'ividu~l signing application) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said awner 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. Sworn to ~e_,_fore me this ........................ day of ..... , ....... ~..: ........... i ...... ~N Fill [~ .~SI(I[E /// ,/ ,* , ~,~z'_. ,,Notary Public, State of New.¥~k.~.-.~.d......~...~.~,d~...~., ................................... Notary Public ...... ~~l~6~is.s?!(qJ, l~3~u~,.~l,o. 52- ~:~600 (Sign6ture of applicant) // (/' s~on Lxg~res ~w~rce 30, 19C~