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Home My WebLink About1137-zFO,I~V~ N:O. 4 TOWH OF SOUT~IOLD BUILDING DEPARTMENT ~OWH CLERK'S OFFICE $OUTHOLD, ~ Y, CERTIFICATE OF' OCCUPAHCY No. Z 845 Date October 20 19 60 THIS CERTIFIES that the building located al .~9..V.~..~.l..~..e..'....~.°...~...~..h.~l.-d. ............... Street ill Colon ~* Lot ]N~o *** _Map N~. ...................... .~lock No ..................................................... conforms substantially to the Application for Building Permit heretofore filed in this office July 11 60 Z 1137 dated ............................................... 19 ........ pursuant to which Building Permit No ........... ~ ............. ~]ated July 11 19..~.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is PRIVATE Obr~ FAMILY DWELLING Roman Pawli~, owner This certificate is issued to .......................................................................................................................... (owner, lessee or tenant) of the aforesaid building. Buildin~ FOI~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS DERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1137 Z Date ................................ ~T~I~.~-.....]~ ....... 19..60. Permission is hereby granted to: ...... Roman.....Pov;-l. ik- .......................................... ...... Gr~e...D~ ............................................... .............. ~o~t%:~ol~ ¥"'",~ ;' %';' to ...... ~Bu!.l d... a~.. m~ d£ ~i..o n...o~ .. ~u ...e~% s .t ,~ n ~...d~t~ !~ ~,n~% ................................................... at premises located at .... }~r/t ~ ,~-....~OV~:;. "~:,?Z .......................................... i~O ................... ................................................. ~ISb,'~ ~' '"' '~; ~' ........................................................................... pursuant to application dated ................................... .~'tt~y~ ...... .~:.~. ....... 19...~O, and approved by the Building Inspector Fee $'""~'~OD"em'sh Building Inspector [ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Perm t No ............................... Application No. ! / 3 '~ APPLICATION FOR BUILDING PERMIT Date .........~..,~ ........... !...I .................. 19...~...0.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su/omitted 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 Jn 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 issuanc.e 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 and regulations. ......... .......... ...... (Address of applicant) Crate wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .................. ~.~.. ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work,~vill be done. Map No: ...~.'...~.~..~ ....... Lot No: ..'~.....~: ......... Street and Number .......~....'..~.~......~....~..~ .................... ~ ~'"'~'"."~" .......................................... Municipality 2. State existing use and occupancy toxf pr,cruises and intended use and occupancy of proposed construction: a Existing use and occupancy .~....~..~J~ ~'~ ~ b. Intended use and occupancy ................... I.I, ...~../ 3. Nature of work (check which applicable): New Building .................... Addition ..... ..X.....~(x,........Alteratlon .................... Repair .................... Removal .... ~ ............... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~.,~.b....O....f']......-T.. ................................ 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 .......... ..~....0. ........... Depth ...~....b..~. ................. Height ............................ Number of Stories ...~ ........................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .1...~ ............. Rear ......... ./...~. .............. Depth .....~....O.. ................. Height ............................ Number of Stories ..... ~ ......... 9. Size of lot: Front .../.'~..;,'~/.. ............. Rear ....... ./..~...~.. .......... Depth ...../....~...~ ............. 10. Date of Purchase ......... /...~....~.....~..i ............................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........... ~/~..~ .............................................................................. 12. Does proposed construction violate/_) ~q z--any zoning law, ordinancez.~ ~°r regulation? ....... .../~. ........................................ 13. Name of Owner of premises...~..~...~.~..~...C...Address ~.L'~'..~: ................. Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... 2' ~.J~k,._~ ... :.~:.."z~...~: .................. Phone NO ..................... Nome of Contractor ............. ~.~ ........................... Address 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. STATE OF NEWcCr'OJ~I<),,/,- _) S S COUNTY OF ..~.) ' .......................... ~~......~..~..'.~(..'...%==... ............. being duly sworn, deposes and says that he is the applicant above named He is the ......................... .~<.....~ ............................................................................................ : ............................. (Contractor, agent, corl~orate 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 app caton; that a statements contained Jn 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 the~rewit~ Sworn to before me this ................. /....'... day of .... ~..t...¥....~...~....5......:/ ..... '~'~"~""~%~)~,ic, state o~ flew ¥~k -P