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Home My WebLink About7720-zama TOWN OF SOUTHO~ BUI~ING DEPAR111ENT Town Clerk's Ofiee Seud~ld, N. Y. Certifia Of Occupency THLS CEETIFIES th~_t the building located at ... ~ds3~e .&v~ .&. ae~traltr~. Map No.. xz ........ Block No.. x~ ......Lot No, .zT,. J~$he~$. ~l~al~l,~. I~.,.~ ~... ~o~s su~y ~ ~ ~~ ~r Bntld~ P~t ~f~ ~ ~ ~ ~ ~ .............. ~eb...1~ 19. ,~ ~t ~ wh~e~ ~ ~ No.. ~ .......... F~... 13..., 19.~., w~ ~ ~ ~ ~ ~ ~ ~ ~ men~ ~ ~e app~ble pro~o~ ~ ~ hw. ~ ~ f~ w~ ~ ~ ~ ~ h p=iw~, a~ ~ e~y. l~op. A. a~o~. e~c). b~d~g ............... ~e ~ea~ ~ ~ W. ~1~. Go~do~. ~b~ ...... ~9~. ................. (~, ~ ~ ~t) of ~ do~d ~i~E. S~o~ ~ ~'~t ot H~ ~v~ ...~.~ ............................ HOU~ ~ ... none ...... ~ .......................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application Z. ............................ Approved ..... ~ .................................. , 19,.......Permit No. .: ............ l ................ Disapproved a/c (Building Insp~or) APPLIGATIO~ 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 propertymust be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code and regulations. ............. (Signature of applicant, or'name, if a corporation) . . ................... ........... z: ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electrician, plumber or builder. 0~r~er ~l'llllam Oerdei Ahma~ Name of owner of premises ..................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) Location of land on which praposed work will be done. Map No: ............................................ Lot No: .................... Street and Number Cerl.e.?.. of Ma~eliae & Ceatra~ Avenue Municipality State existing use and ~occapancy of premises and intended use and occupancy of proposed construction: Teelshed a. Existing use and occupancy .................. " , .. b. Intended use and occupancy .?,eel~lhed & Werkshep · , ~ / , ,' / 10. 11. 12. 13. Nature of work (check which applicable): New Building .................. Addition .................. A teration ................. Repair Removal Demolition .................... Other Work (Describe) Estimated Cost ~ .6_.0.0°00 F (to be paid on filing this ap~l.ication) If dwelling, number of dwelling units ............................ Number of dwellin, g units on each flo)r ............................ If garage, number of cars ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .l~...e.?.~.~...e.][ ........... Dimensions of existing structures, if any: Front12f Rear .121 .. ' Dept 8! Height 8 ~ Number of Stories Dimensions of same structure with alterations or additions: Front [.~..I .......................... Rear 12~ Depth 201 Height ...1..2..~. ...................... Number of Stories .1. . Dimensions of entire new construction: Front ............................Rear ........................... Depth ............................ Height ............................ Number of Stories ............................ Sizeof lot: Front lb~6' Rear ..1..~...~..! .......... Depth .1.~..5' Date of Purchase ,J..~.~..~.. ............................................. Nome of Former OwnerF.,:....[.......?...a..~...~..lt...~O... ................... Zone or use district in which premises are situated.....,~.~...~..-. ........................................................ ' .......................... Does proposed construction violate any zoning law, ordinance or regulation.;> NO Name of Owner of remise~. GOr~lJ A~ Address]3eX F.I.N.Y. P .................................................................................. Phone N .'. .... Name of Architect .~,Z'. ......................................... Address ............................................ Phohe/No ..................... Name of Contractor QI~IIZ'. ........................................ 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 numbers or description according to deed, and show street hames and indicate whether interior or corner lot. Attaehed STATE OF NEW YORK, COLJNTY OF ................................ ~ S.S. ...... J,4(.:....~......~'..'~'.~'~ .... ~ .................................. being du~y sworn, deposes and says that he is the applicant (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 andt°edmake andknow/ ge and be let;file this application; that all statements contained in this application ore true to the best of his and that the Wore will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. .L.9. ........ day.of~:.~.?,...~.. ...................,19.[.~.... ~,, ~_. / ~ _ \ ~ ,~ ~, ~ ....... ~..:...~ ~....,~:f~.....; ..................... Notary Public,. ......... ,.~..~;.~..-...~~tat~,,~,,~/~o,~ (Signature of opplicanJ) ........... · ~1 No. 52-t~,328880 ' '- (~ualified in Suffolk County ' Term expixes Mo. zch 30,. 19 '7~ J 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) 7720 Z Permission is hereby granted to: ...... .'~...Gc~d~on.~ _~.~ ..................................... ........... ~.:t,,~,,~ ~ s...~ .s.1 aa~l ................................... to ~.~id.. ~,~...t O.o.l...sh~d...~...ah~p.(...aac.e~ s ~c~...b~il~in g.). ........................................... ct premises Iocoted ot ...C~I~I~I***A,~e..~..~&~.~.~.~**A.~ .......................................................... ............................................ F.l~ha$**tslar~l ......... ~...~.~ ........ : ............................... ~ ......................... pursuant to applicatio~ dated ....................... .~.~,~ ....... .~.~ ............. , 19~.~'.~.., and approved by the Building Inspector. Fee $.1..0...,..0...O. ............ Building Inspectlr FORM NO. ~ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for ~ew buildings or new use: 1. Final survey of property with a~curate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .,~.......~.¥.lJ.' .................. ~1 :~/ New Building ................ Addition ................ Old or Pre-existing Building ../~. .......... Vacant Land .............. Location Of Property ..~..~(~..~.~...~...~:j.~.~.~`~..~...%~.`.~:~..~.~..~..~.~.~L~```~?1~``~`~:X~.~ .......................... Owner Or ~ners Of Prope~y ..~.:..~.~x~.~...~...~:..~.~.~Z~ ................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Perm it No. ~.~..~.~....~: ..... Date/~,, ~~~:~' .-..(~.4 Z~.~ppl ica,t..~ :.~. ~;~.~~~ Health Request For Tempora~ Ce~ificate ........................................ Fin~ Certificate ....... ~ ............................... Fee Submitted $ ..... .~ ............................ Construction on above described building and permit meets oil applicable codes and regulations. Applicant ..¢.¥.;.z:.....~r:m~.....,¢..-..~....~.~.:-~..e;~-..~.~:~?..h ............................................ Sworn to before me this .... t..q. ........ day of ../..~..~L....!.~!.~ ............... Nota Pub,c LUCY $, (stamp or seal)