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Home My WebLink About2103-zFOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~....~..2..~..3,.. ............. Date .............. ~UgX~.~;..2~.. .................. , lC~8.... THIS CERTIFIES that the building located at ~O.l,lt,~..~ ................................................... Street Map No ....................... Block No ....................... Lot No.~Io. ut.~o~,cJ~...JIe~I...YO3~ ............................ conf~)rm~ substantially to the Application for Building Detroit heretofore filed in this office dated .................................. .~.~l~...~4.w ............. , 19.~t~... pursuant to which Building Permit No~...~,~0.~.... dated ....................... ..~..~.~e.....2..~..~ ............ , 10...6..3..., was issued, and conforms to all of the requirements of the appiicabie provisions of the law. The occupancy for which this certificate is issued is ........ ..................................................................................................................... The certificate is issued to .....G.~.~J~;I,.t;.~.~..~..~.C)~,~...~.~l~...~lf~ ................................................ (owner, lessee or tenant) of the aforesaid building. FOI~H NO. 2 TOWN OF SOUTHOLD 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.° 2103, Z Date ............................. ~"~e...,,~ .......... ] 9.~.~.. Permission is hereby granted to: 6o~.s~t~s..-Boa~...8~op-.~t~ ...................... ................. ~o~t~.~4 ........................................... at premises located at ..l~//B...~t~..~o~,~.....~,.]..~..~r~ek ........................................................... ................................................ ~ot~th~l~r..~¢, ~., ............................................................................... pursuant to application dated ............................. ~T~t~-..~,~ .................. 19..6.~.., and approved by the Building Inspector Building Inspector TOWN OF $OUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ Examined :....":.Z.'~'...: ~ 19.Z..,. / ~p~o~ ........................................ . ~ ........ ~m~ No. ............................. ............ ::::::::::::::::::::::::: ............................... ( d'Buil"in0 In~ector) APPLICATION FOR BUILDING PERMIT .. ........... .~_.. ~ ,. ~?.. Date ............... ~./. ................... : ....... ~....., 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 port of this applica- tion. 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H.EREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Buildinn Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulat ' - ...... tion ~f buildings, additions, alterations, or for removal or demolition, os herein described. The ap ' ':-~kt~-Iaws, ordinances and regulations. L~, ~'~--~ ~ at ~p~c~,~:.-o~; if-~ corporation, \ Non Ifa (Address of applicant) 'chitect, engineer, general contractor, electrician, pr. umber or builder. ' horized officer. (Name and title of corporate otnc~,z 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Numbe, '"'~'~'~"~'~' ~' 'S.'~'.~.~.17..~;.~,..e.'~s:t..~..'F....,4'J':l/Cree~ :-~.~,S.~ ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... ~.~..~.. 4{~..'.r.~.~..~...t~.... .qg..L..~. .................... b, Intended use and occupancy .~..~..~. ~ ..~..~, ..~..~.?...~.~, . 3. Nature of work (check which applicable): New Building .................. Other Work (Describe) Repair .................. Removal .................. Demolition .................. 4. Estimated Cost .............................................................. Fee ....................................................................................... ] (to be paid on filing this application) 5. If dwelhng, number of dwelling units ................................ Number of dwelling units on each floor ....................... ~ .... I, If garage, number of cars 6. If b~siness, commercial or mixed occupancy, specify r~t~te .and extent of each type of use ........ ~/,~./. ................ ~ .... 7. Dimensions of existing structures, if ony: Front ...........~..d ............ Rear ............................ Depth .~'..0. ....................... Height ............................ Number of Stories ........................................................................................................... j. .... Dim,,,bnsions of same structure with alterations or additions: Front ......... ~ ................. Rear ........................... l .... Depth .......... L(.~. .............. Height ................................ Number of Stories ................................ I 8. Dimensions of entire new construction: Front ............ ~.~. ........... Rear .............................. Depth Height .............................. Number of Stories ........ .?.~'/. ............... 10. Date of Purchase ................ ,/~.J~..~.. ..................... Name of Former Owner . 1 I. Zon~ or use district in which premises are situated ............... 12. DoeS proposed construction violate any zoning law, ordinance or regulation? ....... /~.~. Name of Architect .................................................... --,-, ~ · ,~ Address ............................................... ~., ..,../ Phone No. Name of PLOT DIAGRAM Loca~Ce clearly and distinctly ali buildings, whether existing or proposed, and all set-back dimensions f property I. ines. Give street and block numbers or description deed, street names and indi~ whether ibterior or corner lot. f I STATE OF, NEW ,K, ) COUNTY ]OF ............................ ) S.S. ................................................................................................ being duly sworn, deposes and says that he is the opplic¢~nt (Name of individual signing application) above named. He is the ............................................................................................. of said owJqer or owners, and is duly authorized to perform or have performed the said work and to make and file this applicatiorj; that all statements contained in this application are true to the best of his knowledge and belief; ahd that the w~ork will be performed in the manner set forth in the application filed therewith. Sworn to I:jefore me this Notary Pu~blic ............................................................ County (Signature of applica.nt) r TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Application No. c~ / (~ ~ APPLICATION FOR BUILDING PERMIT Oete ............... ............ 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 o detailed description of layout of property must be drawn on the diagram which is part of this applica- tion. 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 applica,nt. 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 o 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ....................(~~o~pp '~e?'i f J '~'~'~"a corporation) ........................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pr. umber or builder. - ,, Name of owner of premises ......... ~,~.~,..~.$A~/.,.,~.,~.,.~.~.. ~"~,7%'"" ........................................................................ If applicant is a. corporaJe, signature of duly authorized officer. ]. kocotion of I~nd on which proposed work will be done. ~op ~o.: ........................................ kot ~o.: ...................... Street and Number ...... .~.~..~7.~.,.~.,~..~&,.c.~,.~..~.~]'...~.~.~..X~r.~,,~ ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... ~:~.~..7..~.~...L~.~..~e~.~Z~.~. ................. b. Intended use and occupancy . ~..~m ~ ~ ~..~ .......................... LocalLe dearly and distinctly ail buildings, whether existing or proposed, and i property lines. Give street and block numbers or description according.to deed, whether ir~terior or corner lot. j 3. Natgre of work (check which applicable): New Building .................... Addition ..../~.... ........ Alteration ..~... ....... Repc~ir .................. Remova! .................. 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 g(~rage, number of cars ....................................................................................................................................... 6. If b~siness, commercial or mixed occupancy, specify n~te and extent of each type of use ........ 7. Diminsions of existing structures, if any: Front .......... ,~..'. ......... Rear ............................ Depth Heiqht ............................ Number of Stories ........................................................................................................... Dimensions of same structure with alterations or additions: Front ......... ~ ................. Rear Depth .......... ~.t~/. .............. Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ~.~. ........... Rear .............................. Depth Heig,'ht .............................. Number of Star es ........ ~.~.!. ............. 9. Size jot lot: Front ....... "~"~'"~')~'~ ~-s- ...... Rear .......... ./~../..~,/~¢¢Depth ........ /.~ ............ ~0. Dat~ of Purchase .......................... J.~.~..,,Z. ..................... Name of Former Owner 1 1. Zone or use district Jn which premises are situated ............... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.~. 13. Name of Owner of premises .~./~/~.m;~..~,~/~.~CJ~ess ........... ,~7.~.~,./~./.~. .............. Phone No.,.~¢.~'..-.~..] Name of Arch tect .................................................. -- -- ~ Address..........._..........:_..:.r_............. Phone No. Namle ....... ............ Address Phone Contractor PLOT DIAGRAM ~ate all set-back dimensions fr, Ov~¢(. STATE] OF :NEW ) COUNTY OF ............................ ) S.S. ................. ~ .............................................................................. being duly sworn, deposes and says that he is the applica~ (Name of individual signing application) above named. He is the ............................................................................................................ ;; .......... :"'[ .......................... I (Contractor agent, corporate OTdce'r, e~c ~ of said owner or owners, and is duly author zed to perform or have performed the said work and to make and file th application;, that all statements contained in this application are true to the best of his knowledge and belief; ar that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .................. [ ..... day of ............................................ , 19 ........ t ~ ~ Notary Pub~lic ............................................................ County (Signature of applica,nt) /