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Home My WebLink About2174-zFORa4[ NO. 4 TOWN OF' SOUTHOLD BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at _E/B,..~/.es.~..C=e.ek..A.~.e, ........................ Street Map No....I[ZZ ............Block No..ZZX ............. Lot No. ~ ....... C.tl.f~O~e.~...][~[,~, .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................................ .~e.~,......)+....., 19.(~3... pursuant to which Building Permit No. ~1~..~..~.. doted ................................ .~.f~..J;;.....)~ ........ 1~..;~ ..... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ......... P.~.lv~t~.. o~e...£~mil¥...d~.llin~ ........................................................................................ The certificate is issued to ..... ~.~..P.QI~OC~ ............ I~e~. ........................................................... (owner, lessee or tenant) of the aforesaid building. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ? ....... Cu. teh~g.ue ................................................... to ..B~ ~:~..an..acld~,t~[~,Ta~d...ma~e...a.J..tel~ett~.on~..cet..~n..~s~..~l~.~g .... at premises located ct ..~/.~.....~-~...C~9~J~..~"~ ............................................................................. ........................................ C.u~;~h~u~..... ~ ,..~.. .................................................................................. pursuant to application doted ............................ (~.~.]~J~ ....... .~ ................. ]9.~.~..., and approved by the Building Inspector Fee $...~.. O0 ............ .... 13uilding Inspector ] FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Application No. c~ I '~ L( Approved t ~ ~! Disapproved~_~ ~_._.._...,.. ................................................... .~z. ~__ ................ ................................ (Building Ins#ector) APPLICATION FOR BUILDING PERMIT ,? Dote ..................... , INSTRUCTIONS a. This application must be completely filled in by typgwriter 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 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 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 port 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 Lows, Ordinances or Regulations for the construction of buildings, additions, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with afl applicable laws, ordinance~.~and regulations. ........ .............................. (Signature of applicant, or name, if a corporation) ............ (Address q~,,~6pplicant) State whether applicant is owner, lessee, agent, architect, engineer, general comtractor, electrician, plumber or builder. Nome of owner of premises ........................................................................................................................... If applicant is o 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.: ...................... St reet and Nu tuber ...Z~.~ ...~.. · .~3 .~.,~,~ .~-.. ~ ~r. ~. ~~<~.., ~.. ~. ~ .................. 2. State existing use and occuponcy of premises and intended use ~nd occupancy of proposed construction. a. Existing use and occupancy 3. Nature of work (check which applicable): New Building .................... Add,ition ..... ~i... Alteration ............. Repc~ir .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ............... ...~...~..O...°......~.--TT. ........................ Fee ................. ~.~..4~. .................................................... (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 b~siness, 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 .......... ~.-'.y..../. ........... Rear .......... .¢;~..~...../. ...... Depth ............ .~...'~...f .......... Height ............ ~../. .......... Number of Stories ............. .~. ............... 8. Dimensions of entire new construction: Front ........ .~CJ...,~K../. ........... Rear .......... ~z~7....~'..../. ....... Depth ........ .'~...~...~ ...... Height ........... ~.../. .......... Number of Stories .........../. ................. 9. Size'.of lot: Front .............................. Rear ................................. Depth .............................. 10. Date' of Purchase .......................................................... Nome of Former Owner .. 1 1 Zone or use district in which premises are situated ....................... .~....~ .............................. 12. Does proposed construction violate any z,~ning law, ordinance orz. egulat[on? ........... ~ .................................... 13. Name of Owner of premises ....~.~...~.~.... Address ..~.~,,.,~, .~..,,~,,.,,~. Phone ~:~..-.~ Name of Architect .....,,,~......,....,~ ................ , ............. Address ............ ¢. .......... .,~ ................... Phone ~-~. .............. PLOT DIAGRAM Loc~e clearly and distinctly oJJ buildings, whether existing or proposed, and indicate all set-bock dimensions fr, property lines. Give street and block numbers or description ~ccording to deed, and show street names and indic. whether interior or corner lot. STATE OF NEW Y,~R~,/ ,,~ ) ~ ~ ...........//~~/~'~~~ ............................. being duly sworn, deposes and says that he is the applical (Name. 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 have performed the said work and to make and file tk 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 ~ , Notary Pub]i~~~~un~'"~'~'¥~'i~'~'~'re of app cant) ....................... C~m~SSiO~ Expires ~arch ~ ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... }..x. ................. , 19...!....Permit No ...................... ~.. ..... Disapproved a/c ................... ~'"".'"'""~"~ (Building Inspector) APPL;CATION FOR B~UI[,DING PERMIT 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, rela¢ionship 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 thi~ applica- tion. c. The work covered by this apptication 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 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, alterations, 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 a corporation) .... (Address of al~51icant) z StaCe whether applicant is owner, lessee, agentr,~_~chitect, engineer, general contractor, electrician, p[umber 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~' -- '~ ' ~'~-- "'--/'~ '-'-/~.~//.~¢~...~--¢_/~¢~...~.~.e~.,~ .~.....~:~¢..~....~.f?~.r.~.~..-..~.~.---- '- ---- --~ ............................ M~nicipa ity 2. State existing use and occupancy of premises and 'intended use and occupancy of proposed construction. o, I:xisting use and occupancy ................................................................................. b. Intended use and occupancy ..... ~....~ .......... 3. Nature of work (check which applicable): New Building .................... Addition ...... ~ .......Alteration ............. Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ..........~..~..~....~. ........................... Fee ................. ~;~'?T~. ........................................................ (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 b~siness, commercial or mixed occupa.ncy, specify nature and extent of each type of use 7. Dimbnsions of existing structures, if any: Front ........... .~T~...z. ........ 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 ......... 5...~.. ............. Depth ....... . .~....,~..../. ....... Height ................ ~..../. .... Number of Stories ...........~. ................. 9. Sizeiof lot: Front .............................. Rear ................................. Depth .............................. 10. Dar4 of Purchase .......................................................... Name of Former Ow,ner ................................................... 11. Zon~ or use d str ct n wh ch prem ses are s tuated ~..= .....~....~.,~.~ ........................................... 12. Doe~ proposed'construction violate any ~3qing ]ow, ordinance or~egulatj'on? .............. ~.. 13. Name of Owner of premises ..~.l.~..~....' ..~....... Address ~-~ff-~./..~.-.~..,~...~.... Phone I~..~..-~.~. Name of Architect ~ ....... ~ ...................................... Address ............. ~/--._...,..,~ ....................... Phone No~ ............. Nam, e of Controct~r,~¢~-,C.~~... Address ..~,.~~..r~.~ Phone~ ..~..~. -~..~.., PLOT DIAGRAM Locate clearly and distinctly afJ buildings, whether existing or proposed, and indicate all set-back dimensions fr property I~ines. Give street and block numbers or description .according to deed, and show street names and indic whether interior or corner lot. A/z: COUNTY OF .~ ....... ) S.S. 0 (Name or inaiviaua signing appfication) ~ ' above nam,ed. He ~s 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 tih is application; that all statements contained in this application are true to the best of his knowledge and belief; ahd that the work will be perforrned in the manner set forth in the application filed therewith. ., Sworn to before me this ~ . ~ .............. Notary Pu,blic K'~ o~nt~/ ./z, , ~ , . }~ (Signature of applicant) No. 52-0344963, Stfffoll( County