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Home My WebLink About411-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~..~,g .......... Date ........ . ............... ~',g~..,1, ................ , 19,.~t.0.. THIS CERTIFIES that the. bui[diqg located at Map No. ~e Block No. ee~e Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................... ~I~U~...~ .......... , 19..~., pursuant to which Building Permit No ....... ~....~ ......... dated .......................... ~.~.~...~.....~..4. ...... 19..~...~..., wa,s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ........ ~ ....... ................................................... ~.~:.VA~...0~I~ .. ~'J~X~.. ~T~r~3;~ ....................... ...................... This certificate is issued to ~*11.~1~.1~ ..~,.~'~.~¢,....~.WI~'. .......................................................... (owne~', lessee or tenant} of the aforesaid building. FORM HO. 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 411, z Permission is hereby granted to: ~Icer & F&oJce&a~et~....~bfG....];)e~o.tAlir...~a~t4~ ................ ............. ~ o:,.d;~a ,.~.~.d.~..... If, ]~. ............................... to ...~, ld.. ~J~..~dd~.t~.~.~)~,..a~..l~x~..d~t~ 1~,~ ...................................................... at premises located at .:~.~l'~'~l~..~,OJ~t .................................................................................... .......................................................... ~.~])or.~ r.... ~ o :Z, ................................................................ pursuant to application dated ............................. ][~[JJ~..~..~..~'i~., and approved by the Building Inspector Fee [ - Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 5OUTHOLD, N. Y. , praved ........................................ No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by t~/pewriter 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 location. 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 purp°se 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ~t ' ~~"(Signatur~of appl'cant, or name, if a corporation) .......· .......... ........... (Address of applicant) State whether applicant is owner,~e, agent, a~rchitect, engineer, general contractor, electrician, plumber or builder. Nome of o er of ........................................................................................ 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. Map No: .................. ' ......... J ................ Lot No: ............ J ....... Street and Number ........... ~......'. ....................... .~......~...: ...... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xisting use and occupancy ........................................................................................................................ b. Intended use and · ~ .� w^ 3. No(u,n of work (check which applicable): New Building--.......�\6Jitkon ...^..... Alteration .........~ Repair ..........Renonvo| .—....^.Demo|itio ...—..........Other Work (Deschbe) .......... � �� * � � �~�~~ 4. Estimated Cost......x.�.....................Fee .��......~...—..—..................,....,.. (h� 6epoidonfi|ing this application) 5. |f dwelling, number vf dwelling units................................Number nf dwelling units on each f|oor......—.—.,.. If garage, number of co/u—..,.—......—~.~—.~...........—...---^---^.—~--...^^^..~.... 6. If business, commercial or nnixoJ occupancy, specify nature and extent nfeach type of use.............................. 7. Dimensions of existing structures, if any: Front , F�............... Rea r ........ �� ......... Depth ...... ..,.... ' ��r Height .—.��c—.....Nunnbrr of Stories ..—,.....—......—..~...~—......—.—.....—........... Dimensions of some structure with alterations o, additions: Front .... ........ Rear ...... ................... Depth .... ......, Height .... /A..............Number ofStories ...../.......... 8. Dimensions vf entire new construction: Front............�.°�°~....... Rear ......../.'�........... Depth . ........ Height .............. Number ofStories ............................ 9. Size of lot: Front ...��~r?..... Rea ..... ..... Depth ......... %�06........ 10. Date of Purchase ........................................................Name of .................... l ). Zone or use district in which premises are situated................. ��....�� .............................................................. l2. Does proposed construction violate any zoning ko°, ordinance or regulation? .................................................... 13. Name nf Owner ofp rem ises.AX\Cm.'nr......!`i ness ~ �/}<��L.��^v........Phone N[l .................... Name of Architect........................................................Address ............—..—....Phone N0. .................... Name of [on�ro��n� /�« 4c��.�l� ��~�^..Address .........Phone N{l .................... ^ 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 names and indicate whether interior or corner lot. � �»' � o^� ` �� ' STATE OF NEVtY� (O S S. ............... ...........P27-111 -i......... .......being duly sworn, deposes and says that he is the applicant ame of' individual signing application) (Contractor, agent, corporate officer, etc.) of said owner 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 m4aqVP4 the application file �kfoOD& therewith. Sworn to before me this b (Signature of applitarit) ` ' � ` 1~O~,~ ~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE UT.OLD, N. Y. ~p Dyed ........................................ ]9 ........ Permit No ............ ....... ........... ........ .......... ( uilding In~ctor) APPLICATION FOR BUILDING PERMIT ............. ....... ...... INSTRUCTIONS o. 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 location. 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signatur~f a~plicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner,/~ee, agent, a~chJtect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises......~....~T...~..-.....~.~....i .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on w ich. proposed work will be done. Mai> No: ................. ~ ......................... Lot No: .................... Street and Number ~../-.~'. .......~.....~.....~.;. .................. ~.......,~.....-.~...: ...... Municipality 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 ~ t occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New ~Bufll~i~.i~ ................. Addition .................... Alteration .................... Repair .................... Removal .................... Deme/4~io~,...,, ........ ~..?Other Work (Describe) .................... (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, specifl/r~ure and extent of each type of use .............................. Height ......... ............. Number of Stories ..... ./... .................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. NumBer of Stories ................................ e. Dimensions of entire new construction: Front ............ ./.....'~... ....... Rec~..~.J;~ .......... Depth ..../..~... ................. Height .......... ./....~. .......... Number of Stories ..... Z ................... Dote of Purchase ........................................................ Nerne of' Fcim~e~ Owner ........................................................ Zone o(. use. district, in which premises are situated ..................... .~......~ ............................................. 12." Does pmpos&d co~,~tructi0n.violate any zOning /aw, ordinance or regulation? .................................................... ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly end distinctly all buildings, whetba~r existing a~ ,l~ml~ee&, and indiea, te all set-ba~k dimensions from property lines. Give street and block numbers or description according to.deed, and snow street names and it~licate whether interior or comer lot. sworn~ del~oses and, says that he is the applicant of ~id owner or OWt, er:, 3r,,:l : :lul, .'.~lh?.mzel~' ,t; I~rlOl~13~ ¢,1' I'N~f,~ ~ldO e~l I . .~=,j : k .'. ~ h: ,3 · ;r,d , · this appltcatfon; that ali Si-~mln,5 :onTalned In Ihi? aPplacofk~ (~e Jrue I.,) I['~ I~t qt .hit iC~MJ~ GnJ I~r,et and that the work will be performed in the ~r~lll~O~.h in the applicatlon~c~ited the.ri)wJt~. ~ ~ Sworn to before me. this, .. -~'~MM, s~t~.w~ ......-- /~'2~, ~., ~)'~ ~. ~ .~.. ....... ~.....~..~..~.. dav, L of y. ...... ~ ....... ..~'.~mm~-~°~/~c~'°~ (Signature of ~)plicant)