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Home My WebLink About3928-zFOI~M 1VO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I~ TOWN CLERK'S OFFICE* SOUTHOLD, N. Y. CERTIFICATE OF occUpANCY THIS CERTIFIES that the building Iocoted at ~.~//..~t.~ .......................................... Street Map No..~.~.e. ......... Block No ....................... Lot No. ~',S&.7.J~..~O.U.t;J~O~.Cl,,..~T~.~...~'O~¢~ ............ Uec~ 1663 conforms substantiolly to the Application for Building Permit heretofore filed in this office doted ............. .~...~.~..~.....],., ............................ , 10...~..~.. pursuant to Which Building Permit No. 3...9..2...8.....~... dated .......... .~.tA.n.~...2.~.* ......................... , 19..6..8...., was issued, ahd conforms to all of the requirements of the applicable provisions of the law. The occupancy for wh'ich this certificate is issued is ........ ... ~r~v.a~..e...,O.n.e...~...a~...~.~. ~.e.~.~.~g. ................................................................................ The certificate is issued to ............. .~...O..~.,~.,~.....&....~,~....O..~..~.~.. ..................................................... (owner, lessee or tenant of the aforesaid building. Building Inspector FOR~ NO. ~ 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? 3928 Z Permission is hereby granted to: Southold to .~!.~.~ .3...~ .~. ~.~..o. ~...~...a~...~.~:li~.~ ..~.3,3..~ , at premises located at ........... ,~,,...~,,~.,~O~,,~,,~,,a,,~ ................................... ....................... :.;.....Geo~e..~ee~..~.~a~ ...... ~eU~e~d,t.,.~,~,~ .......................................... pursuan,t to application dated ............................................................ , 19 ........ , and approved by the Building Inspector. ~o00~ Fee $ ........................ ...... /L~z,J ........ , ............................ ~t ............. / ~ Building Inspector / FOI~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENTI TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am ned ......... ............ ,,9:..*: Approved ...~...~..5......, 19.~.~Permit No. 7 ?~ ~ Z-- Disapproved a/c ....... Iq'~ ~b~,..: ~-.~ ...~¢~ ~;~;~ .z~ ........ APPLICATION FOR BUILDING PERMI~ ~ate ....ii~'.'.~...:..." . ,9...X..: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ir~k 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 d~n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building inspector will issue ~ 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 isjuance 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 f6r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordir~r~e-~,~buildihg code, ho~sing,c~,e, and regulations. ................................... ? .................. ......................... :;~'~;~T :~":~'~:,;~'~i": ....................... ...................... , ..~...4'~>~x~S'''/ . ... '"': .................. :;:::Z::: ............................................. iName ot owner ot premises ...'...l.;.:'.;....z ...................................~ ............... ;./.. ................. ~. ...................................................... 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. M~qp No.:(~....~..C.~.!...¢~..:.~..~.../...~...~... Lot N~: ................................. ...-..: ......................................... : ............. ~ic~...-.i~: ......... ~ ......................... 2. State existing use and occupancy of premises and intended use and occupancy,of prbpos~ construction: ~. ~.,~,,n~.~o.~o~,..~ .......... :~:,:C ......................... '. ........................................................................ b. Intended use and occupancy ................... ~ .............................................................................. 3. Nature of work (check w applicable): New Building ................ ddition '// Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this opplication) 5, I~: dwelling, number of dwelling units ............................ Number of dwelling units on eoch 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 .. ~ ~ ............................... ........................................................ ...... ' Dimensions of same structure with a,lterations or additions: Front .............. ..~,..(../..~. ........... Rear ....... ..~.....~...'~. ......... Depth ,..,'~,,c~..~7...'~....~..~ ....... Height ....... ..'~..~..~ ............. Number of Stories ..........~....~,,,~ ............. d' 8. Dimensions of entire new construction: Front ~,~,zj/ Rear ~Z'" Depth ..... ~ ................ Height ..../..~..¢~..;.~. .... Number of Stories ..... ~..A(...~,. ........................................... 9. Size of lot: Front . /.,~"2/ Rear ....... ~.~.~'..~ ................. Depth / 5'"c~ z ............................................. 10. Dote of Purchase .............. Z'...~..'):....~... .......................... Nam,? of~ F~wner ............................ , ................. · ......... 11. Zone or use district in which premises are situated ............ .~ .................................................................................. ~ ' ' Does proposed construction violate,~:~_,,_~.~/.,any zoning ~,~v., ordinance or reg~u(~,?_o,n~_,~:~..~.....~..... 12. 13. Name of Owner of premises ...[...c~..,,~','....?...~..~..Address .......... ..~Z?.-...Z~..T...~..Z ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ................. ,.f.~.~' '~.~.~"~c.~.~'~''~'~.L~:~.~'~'/.'?~:~..~:.q.~..~?.being duly sworn, deposes ~nd s~ys that he is the applicant (N6me of individuol signing appl~ation) obove n~med. He'~s the' ......................... ~..~..~ (Controctor, ogent, corporate officer, etc.) 5f~i~5~n~o~-owne~ and is duly outhorized to perform or have performed the said work and to make and file this application; that all statements contained in this application a~e to the best of his knowledge and belief; and ~r~h~b~fore metalsw°rkwiHbe~erf°r~e~ in the manner set forth in the appl~tion)filed therewith. .......... ,. of .pphc, O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. A~roved 19...~.....~"Permit No...?....?...~....~7..~...?... Disapproved o/c ....... A~..;~..~ ~......~ ~ ~ ......... ....... ........................ (Building Inspector) APPLICATION FOR BUILDING PERMI~ 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 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 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 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, os herein described The applicant agrees to comply with all applicable laws, ordin,~l~'~building code, hoHsing,e'~e, and regulations. (Signature of applicant, or qame, i.f~q corporation) (Address of applicant) State whether applicant is owner, lessee, agent, orcNitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~...~..~..../~......~......~.....~.~..~ ...... ....~....~.....~.....~....%.~.....'~...~ ....................................... If applicant is a co~orate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. M.~pNo.:~...~.~..~.~.kotNo.: Z..~...~..~..Z..~.... Street and ........ .................... 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 ...... ~... '.~.~ ........................................................................................... J Repair .................. Removal .................. 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 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 ...... ..~...O~..../~.~.. .............. Depth .....~...~...f ....... / ,-v Height ......... ../.-~. ......... Number of Stories ..............~......~ .......................................................................................... Dimensions of same structure with a. lterations or additions: Front .............. ..~...?..?.~../. ......... Rear ....... ..~....~..~./.~...( ...... Depth ....~....~...i-°~.....~...(.~ ....... Height ....... ../..~..~ ............. Number of Stories ..........~....'~-.~. ............. .................................... Rear ....,.~....~.. ............... Depth ..... ..~...~.. ............ 8. Dimensions of entire new construction: Front ~ ~ / / ~ Height ..../..~...~.../. .... Number of Stories..........~../v~-... ...... ......... ....... .................................................................................. . 9. Size of lot: Front ........ ,'(...~..~.. ............ Rear ....... ./..?.~ .................... Depth ....... ?......~..' ................ f-~ _/ 10. Date of Purchase .............. /...~..~i'~...~'... .......................... Name of For~,er ~:)wner ...... ..~-~..~.~.:......?.:...~.....:.i./...--.~./. .............. 11. Zone or use district in which premises are situated ........... i~L~.....~ ................................................................ 12. Does proposed construction violate any ZOnrr~l ~.a~v., ordinance or reg~ut~io~n~_,~::.~......~..... ....................................... 13. Name of Owner of premises ...~....v...7.~..Address .......... ..~......-:.T....~..Z ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. sT~'FE OF NE'W,fYORK,, ~ COUNTY OF_~'-~.~,~-/~.~;3..:(~..,~'~' / ~ f ~1 ~'1 , ',7, ................. , orn, o,es he ,, (N6me of individual signing app~ation) above named. He is the ......................... ~.~>,~: ........................................................................................................... (Contractor, agent, corporate officer, etc.) off-~d owner or o~nersT end is duly authorized to perform or have performed the said work and to make end file this application; that all statements contained in this application ar, e~c~e to the best of his knowledge and belief; and that the work will be perforWi~l in the manner set forth in the appli, c'6tion~filed therewith. Swo,L.~to b,~fore me this ........ ....... ..... ........................ , :':';,~ )J, ,- / ......-.b~../-..~ .......... J~~ ............ Notary Pubhc, ' ~7 ' -o ,~.~ County ,gnature of apphcant) · . ' -.?.; .......... ~...~:~--.....~.(/..//~....:~ ........ ~0.,~^ ~. ~^~^~,~i~