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Home My WebLink About2774-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~/~.....j~;~.JJ~J ........................................ !Street conforms substantially to the Application for Building Permit heretofore filed in this office dated dated ................................. .. 26 ...... ,19..~'., was issued, and conforms to all of the requiremehts of the applicable provisions of the law. The occupancy for W~ich this certificate is issued is ...... :.~ (ownerf lessee or tenant) of the aforesaid building. Building Inspector I FORM 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) 2774 z Date ............................. ~.....~,~. ............. , 19.6~. Permission is hereby granted to: RoJM,~.~..R...2rown ........................................... ....... Mo~n..R~d ................................................... .............. ~l~f...O,r. eent~ y ...N,,.J', ...................... to ..l~ulld..zmv..bua.J,n®a ~ ..bu.~..1.d~g .......................................................................................... ot premises Iocoted ot ...... JJv/'.~.-..-J~Jll.~tl..JJOll~ ...................................................................................... ..................................... .W[..l~.e~n~'.t,...[,..I.,.t... ~t, .Z..,,. .................................................................. pursuant to application dated ................................... ~ ....... ~'. ......19~r~...., and approved by the Building Inspector Fee ~.~. n .~. ............ Building Inspector FO/tM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ..... , Approved ""..'"' ....... ./.._....f.~. ........... , 19/-] .... Permit No. ~.... ,~.._Z...,~,]~ Disapproved o/c .......... ,~.~::'~7~ .............. ~,~<~7~ ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........ ~ .................. , ]9 .... INSTRUCTIONS a. This applicalion 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 issue.nce 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Si~ndture o applicant, or nome, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. . ................................................................................................. Name of owner of premises ~...~ 2~'~'~/~- ~ ~.D., ..~..'.I..'~... ~ ~ ' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of ~and on which proposed work wilJ be done. Mop No.: ........................................Lot No.: ........................ Street and Number ~..~.~..~......~....~.~.-~..-.~.....~....~....~.. ~..~..~.~...~.:~'~<] ~'~'/~' ~'~[.~... .............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ,~......~.~ ........ : ...................... b. Intended use and occupancy ..... ~ ..................................................................................................... Natlre of work (check which applicable): New Building .................. Addition .................. Alteration Repair ................... Re,rn~oval .................. emolition .................. Other Work (Describe) 4. Estimated Cost .~.....,~....~.... ....................................... Fee (to be paid on filing this application) 5. If d~welling, number of dwelling units ............................ Number of dwelling units on each floor ....................... If g~rage, number of cars ....................................................................... : ........................ 6. If t~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dimensions of same structure with a.lterations or additions: Front .................................... Rear Dep}h ................................ Height ............................ u er of Stories ............................... 8. ui~ensions ~ e~dre new cons ion: vro ..... ~..~. ......................... ear ............................ epth ........... Hei~htz~ ..... ~ ........2M~,~Number of Stories ............. ~..~....~. ....................................................................................... ..... R~r ....... .......... Depth ...~...T..~...''~' 10. Datb of Purchase .....~...Z.~..~.~..~ ......................Name of Former Owner ~/~ d~ 11. Zone or use district in which premises are situated ........ ~.~.~ ................... 12~ Doe~ proposed construction violate any zoning law, ordinance or regulation? ........ ~.~. 13. Na~e of Owner of premises ....~.~'~.~.~,~,~dress ..... ~~m.~ ....... Phone Na~e of Architect ...................................................... Address ............................................ Phone No. Na~e of Contractor .................................................... Address ............................................ Phone No. ~ PLOT DIAGRAM I_ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate alt set-back dimensions property ~jnes. Give street and Nock number or description according to deed, and show street names and whether in}erior or corner lot. . STATE OH NEW YO~K, -~ ~SS cou w ' · J(Name aF individua~ signing applicatio~ ............ abow~ na~ed. He is the .............. ~:.~::f~-.-.~ ............. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfarmed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in the manner set forth in the application filed therewith. Sworn toJ: . ~%,~ef°re',me thiSof x ~ 19.....~ ~ I [/ NOTARY PUBLIC, Stato of rlcw York ] v ~o. 52-3233120 Suffolk ~ Term [x~ires March ~8, FOP~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined .....X...: ..../'"/"::"J'"'"'~'"" 19.~...~'.. Application No?~.:,.../.....':....'.~.. ....... Approved ........................................ , 19.' ....... Permit No. 5: ......................... Disapproved a/c .........~..~..~..~..:-.'~; ....................... .~....~T.Z;.~.~ ......... ,~>~,..-~..: ...... ................ ........................ APPLICATION FOR BUILDING PERMIT Dote ............................................................ , 19 ............ 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 punic 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 issuo.nce 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 sh~ 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 Sou}hold, Suffolk County, New York, and other applicable Laws, O?di~ances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apblicant ogrees to comply with all applicable laws, ordinances, buildi~n,~ cod~, ~and regulations. (Signatu~ce.~f applicant, or name, if a corporation) (Address of applicant) State whether applicant? o,~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicaht is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wiI,Lbe done Map. No ............ Lot No.' ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occapancy ........................................... 3. NatUre of work (check which applicable): New Building ..... ~ Addition .................. Alteration Repair ............ :~... Removal .................. Demolition .................. Other Work (Describe) ] .~.(...~. ..................................... Fee 4. Esh ated Cost ...~.....~,~ (to be paid on filing this application) 5. If dJwelling, number of dwelling units ............................ Number of dwelling units on each floor If garage, number of cars 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use .~.~'.~.~...'~.Z.~.. 7. Dim~ensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dimje. nsions of same structure with a.lterations or additions: Front .................................... Rear ! Depth ................................ Height ............................ Number of Stories ................................ 8.Dim!ensions of entire new construction: Front ........ .~......~.. ................. Rear ........ ~ ........... Depth Height ..../~...,P. ...... Number of Stories .......... 9. Size; of lot: Front' ...~.~.../f~..~. ..... I~,ar ...... .~..'~. ..................... Depth , ,~,. ,~,,,~, 10. gott of Purchase ....'~.....~..~.4.-~..,,~.--~ ....................... Name of Former Owner .,/~,~.~...~'~~~. 11, Zonb or use district in which premises are situated ...... .~.~.'~'.~":..~.-~' ................... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ...... ~....~. ..................... 13. Na+e of Owner of premises ..K.~..~...~..~..~....~...~..~ddress ....~.~..?~..~....~.....'~.. ....... Phc~ne Name of Architect ...................................................... Address ............................................ Phone No. Nam[e of Contractor .................................................... Address ............................................ Phone No. ] PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block number or description according to deed, and show street names and whether in~ erior or corner lot. I STATE OF NEWyORK, ~,~ /cc COUNTY ',OF ..~....,.f .... ............ ~ .................................................. being duly sworn, deposes ond says thot he is th~ o ..... ':(Name of individual signing application) ...... above non'ed. He is the ............ ~ ............................................................................................................... (Contractor, agent, corporate officer, etc.) of said oW, her or owners, and is duly authorized to perform or have performed the said work and to make and this application; that ail statements conta.ined in this application are true to the best of his knowledge and belief; that the w~rk will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this ........... ~'~'~"~Dday of ...~~ ....................... , 19.~.~ ~ ~.Z~ ~ --~.~ Notary Pu~li~.~....~.,.../~ ........ ~ REGEr. IT~ (Signature of applicant) ' ~ ~OTARY PUBLIC, State of Hew York No, 52-3233~20 Suffolk Cou~t~ , , .Term Explro8 March 30, 19~