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Home My WebLink About3765-zFORM NO. 4 TOWN OF SOUTHOLD BI. WLrHNC, DEPARTMENT Town (ilerk's Office Southold, N. Y. Certificate Of Occupancy .... Date ........... THIS CERTIFIES that the building located at .8~...§lOa~ .......... Street Map No...~. ....... Block No. ~ ....... Lot No. ~,~... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... J~l.. ~<) .... , 19.6~. pursuant to which Building Permit No.. ~?~. dated .......... J.a~... ~0..., 19.68., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .?r~v.~te..ane. f.~$~..dwz~.l~g ...................................... The certificate is issued to . ~tar~.~ .~a~lztt~..~r ...... ~'n$l* .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... N.,R, .......................... Bmlding Inspector FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTblENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? 3765 Z Permission is hereby granted to: ............. ~..~.t..~.e..~...m..~...~.....~...,mm~etts ...................... ~l~a~a.,L~ ....................... to ....I~.1.4...~..~..~.;~.,~.~...~...~...~ ................................................................................ at premises located at ,~-'~..~.., ~..~.~ ........................... ~ ......................... .............................. i~ .~....~..~.........~,.~. .......................... .~ .............................................. pursuon,t to application doted ..........~ ................... ~{}~/~I~ [....~1;~...., 19.~.., and approved by the Bu.ilding Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE I~xomined ....... , 19 ........ Approved ...~.. ................ ~.~. ............ , 19...~.....Permff No. ...... .~...'............7 ~ ......... Disopproved o~~...~~ (~ildi~ I~ctor) 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 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 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 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 P, egulations for the construction of buildings, additions, alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ....... .......................... (Address of applicon) State whether applicant is owner, Alessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ..................................................................................... If applicant is a. corporate, signature of duly auYhorized officer. · ~ (Narl~ and~itle of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number .~......~z~.. ............................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of prop,o~d, cdes~f'ruction. a. Existing use and occupancy ................................... : ............... .....;,,.%. .................. b. Intended use end occuponcy ............................................... .~..:.... ......................... 3. Nature of work (check which applicable): New Buildihg .................... Addition ....~.. ......... Alteration ...... ............ Repair ................. .~emova! .................. Demolition .................. Ot~r Work (Describe) .................. , 4. Est mated Cost ~...~, ~. ~. ....................................... Fee ........ ..~'~.,.~...~. .................................................... i ........... (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 ...... ~ ......~ ...................................... ...... ii/ ~-- J .... ,~ ........... g~mens ons of same structure w~th alterations or addmons: Front ....... ..,~.~.. ................ Rear ....... .~.......-,~.. .............. f ! Depth ....... .~.....~, ............... Height ........ ./..~... ................ Number of Stories ........./'.. ..................... 8. Dimensions of entire new construction: Front ........... .~.....~ ........... ' / '~ t ...... Rear .......... ..'~'... .............. Depth ....................... Height ........ ff..~.../. ............ Number of Stories ........ .,/. ................... ~ I j 9. Size of lot: Front ....... Z~...-~..~....~... Rear ........ /...~....~. .............. Depth ...... ./..~.....'.~. ............. , ~, , 10. Date of Purchase ..... ./..~....~...~. .................................... N.g~n~ of F~rmer Owner .......~..'..~...~ 11. Zone or use district in which premises are situated ..... ~....~....j,~. .................................... Does proposed construction violate any zonina law ordinance or rec~ at on;~'";'-'~'"'>'~" 13. Name of Owner of pram se§,~/.~~ddress .'-,~...~,.~. ~'T'"'.'"~ '~"7~' .......... ,~ ...... .-~-r.~.:.¢./,.. rnone r~o. Name of Arch tect ~ J~'~-'~' ~ ~' ANdres- ~' ,-- ,. ......................................................................................... t-none INa ....... i ........... Name of Contractor Z..~...~..~ ...... Address .~..~~.. Phone No.7~'J;~..~..~ PLOT DIAGRAM Loco.te clearly and distinctly ali buildings, whether existing or proposed, a,nd indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and i'ndicate whether interior or corner lot. STATE OF NEW '~RI~,~ ,q/ ) e¢ ...... ~t~l I I~T~~II. ........................... being duly sworn deposes and says that he s the appl cant \ (Name of ir~ividual~igning application) above named. He is the .....~~ .................................................................................................. ........ (Contractor, agent, core,rate officer, etc.) of said owner nr owners, and is duly authorized to perform or ~ave performed the said work and to make and fife 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 ~ore me this~, . . ..... day~f ...~..~. ......... 19~ ~QuolifioO ~n 8uffolk Count T*rm [xpl~s Marc~ 30, 1~68 FO~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Exomined . ..~.r. ........ 1 ...~.. Approved .................................. 19.::.....Permit No.....~...7..(~..~..~.Z,~. ~sapprovea a/c ....... :,::.;~, .~..=/~ ................... 2:~-- 7z ......... ~: ......... ......................... .................. ~.:L::;>~- .......... .-.~~: .............. , . ~.M (Building I~pector) / APPLICATION FOR BUILDING PERMIT Date ~ ............... , 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 bcotion 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 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 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, O?dinances 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. (Address of applicant) ~ State whether applicant is owner, essee, agent, arch tect, eng neet, genera contractor, e ectrician, plumber or builder. Name of owner of premises ...... .~~...~ ............................................................................... If applicant is o, corporate, signature of~,uly authorized officer. { (Name~d t~e of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ....................,. Street ond Number ............ · ................................................. : ...................................... Municipality 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy b. Intended use and occupancy ............................................................... ,~ ........ . ........................... 3. Nature of work (check which applicable): New Building .................... Addition ...... ~. ....... Alteration ...... ~ ............ Repair ................. ~,P~mova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ...... .,~..f~-,,.4~...~. ..................................... Fee ........ .?~../~...'..~..~. ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........~ ................. Number of dwelling units on each floor ................ i ........... If garage, number of cars ................................................................................................................................ ~ ........... 6. if business, commercial or mixed occupancy, specify n~ture .and extent of each ~,pe of use .................... ~; .............. 7. Dimensions of existing structures, if any: Front ....~...?. ................ Rear ..... ~...,.,~... ............. Depth . .~..?... ~ .... Height ..... ,,~,...~...-~...z. ........... Number of Stories ...........o~. ...... ~ ............................................ iii ....... Dimensions of same structure with alterations or additions: Fror~ ......... ~../.. .............. Rear ...... ~..~i .................. Depth ...... ..~....~....x. .............. Height ....... .~...'~..../. .............. Number of Stories ............ Z ................ 8. Dimensions of entire new construction: Front ....... ..~....z. ............... Rear ........... .~...~ ............ Depth ....... ./..-~....~... ........... Height ....... .~...~....z ............. Number of Stories ........... ?. ................. 9. Size oF lot: Front ........./..Z?.~..~...~. ........ Rear ........ ./..c~...~...i .......... Depth ....../...~.....~,.~. .......... , , 10. Date of Purchase ......... .~...~....~....~... ............................ No,me of Former Owner ...... ..~..'...~...-.....~.~'. .......... 1 1. Zone or use district in which premises are situated ............ ~....c~...~.~ ...................................................................... 12. Does proposed construction x~iolate any zoni.ng law, o~'dinance or r~gulation? .................. ~ ...................... '. .......... 13. Name of Owner of premises~.~~Address .~.',~,~...d~...~...~..,.. Phone No./'~,~....~.~l Name of Architect .................................................... f ~"'~ ~'Address Phone No ................... Name of Contractor ~,..~....~......~... Address i~]'.ii~iiiiiiiiii Phone PLOT DIAGRAM Loca,t9 clearly and distinctly ali 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 lot. STATE OF NEW ~OP~I(~, 9/ ) c c COUNTY OF ...~.'~,~,~,~.~..~.....) .... .... ~......~ ............................. being duly sworn, deposes and says that he is the applicant (Name of ~.,._~plica~tion) above named. He is the ...... x.~..ccv..(..-r..,¢~.~...~, ................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owneF 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 before me this ~ ...... ......... .......... ,... ...................... ....... Qualif~d in ~tto~,~ ~u.~o