The URL can be used to link to this page

Home My WebLink About2005-zF(~]~I NO. 4 TOWN OF SOUTHOLD BUILDING D~EPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...W~.....F. le~..~e~..~d ..................... Street Map No .......l~lee, t.... Block No .....~lr~ .......... Lot No ...... ~ ......... C[~i~;~t:Le*~...l~..~o .......... conform~ substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~/la~'~h, ......... ,*b(~ ...... , 19..63.. pursuant to which Building Permit No..,~2.QO.~... dated ................................ }/'~'¢h.....~0, 19...6.~., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ........... ~,.~.v~te..o~e...~i.ty..,dwet.t~g .................................................................................... The certificate is issued to ..... ,~O.~e~.~,..Gl~[ ................ QW~'. ....................................................... (owner, lessee or tenant) of the aforesa.id building. H.D, Approval ~T~.n,e 1963 FOl~l~l[ 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.o 2005 z Date ...................... J~a~.l~JJ....~O ............. 19..6.~. Permission is hereby granted to: Chet Or !oYski..... A/C ..R~I~ S,. G&s$, ..................................... ............. Cuta~o~.uo ............................................ to ........ ~u~:Lcl..n®~t...one.. ~a~l~,],~'.. ~lt~;i,~;~ng .............................................................................. at premises located at ...~tl~,~h..~...JJOl~J~..(~l~OS~..~J ............................................................... ...................................................... Gutehe~ .................................................................................... pursuant to application dated ............................ j/~.Gj~ ....... jj~ ............ 19~.~..., and approved by the Building Inspector F~e $.....],0- .............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined (~ ~- ~- o t9...!.? Approved ........................................ , 19 ........ Permit No ................................. Application No...~.~?....~.. ........ Disapproved a/c ............... ~ ........................... .............................. ~..~ld.~....~.-. -. ....... -' ' ' '.' ............................. APPLICATION FOR BUILDING 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, relationship to adjoining premises or public streets or ureas, and giving a detailed description of layout of property must be druwn 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 progresF of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whutever 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 pursuunt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other upplicable 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 applicant, or pame, if a corporation) .............. ' " ' ........................... (A~tdress of opplicah~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~-.~.~....5.~ .............................................................................................. if upplicunt is a corporute, signuture 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 ~ Municip(~lity 2. State existing use and occupancy of premise/~.a,n~,~ntended use und occupancy of proposed construction: a. Existing use and occupancy ....~b..~ ................................................................................................. Intended use and ('/~ f:.'~ ~ .~.':.'..~:r..m~...'z. ~. ~ .................. b. occupancy ...,'.z~ . / 3. NaCure of work (check which applicable): New Building ....... X ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... ~...~.~....0...~.....O .......................... 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 ............... '...."m. ......................................................................................................................... 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 ...~'~.~ ................. Height ..... j..~...! .............. Number of Stories ....... ~ ............. 9. Size of lot: Front ....... ~/. .................... Rear ....Z'..(...~ .............. Depth ....... /(...~....~. ..................... I0. Date of Purchase ....~...:z...../:.~..~.g,r .................. Name of Former Owner .~..~...~.~..~ .~...~ ........ or uso district promises are ...... t....:.~... ........................................ Zone 12. Does proposed construction violate any zoning law, ordinance or regulation? ...,~?.....?. ...................................... 13. N me of Owner of p em~ses ....~...~...~..~.....Address ...................... ,,~.~ .~ .......... Phone No ............. Name of Architect/~'~T-) ~ /J~)~/2 ,. ~ , Address ~~:~i':.~.'iiii:; PhorJej~, ~--N° ..................... Name of Contracto ..~,u~C,~J~..~ ................... Address Phone No.(~..~..~...~,~ ...... PLOT DIAGRA,M 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 / -- I STATE OF NEW YORK, )cc ~) ,/Z~,,~'~ COUN~TY,-,O F .......................... ) ..... /I ,..~_.:~..~.~ ............................... being duly sworn, deposes and says that he is the applicant ~' (Name of individug~ ~'~~igning application) above named. He is the ...:~~....~....z ................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authoriz~t~ ~e~ or ha've performed the said work and to make and file this application; that all statements con~,t~-~-~n are true to the best of his knowledge and belief; and that the work will be performed in t~.~3~flf~r~n~ the application filed therewith. Sworn to before me this ~,n~,ss~, Expires ~r~ ~~day of ~ , 19 ........................ .... T'" ......................... Notary Public, .~..~,...,~....,.(~[y (Signature of applicant)