HomeMy WebLinkAbout1037-zFORM N,O. 4
TOWN OF SOUTHOLD
I~U~LDING DEPARTMENT
TOWN CLERI('S OFFICE
SOUTHOLD, N. Y,
CERTIFICATE OF OCCUPANCY
No ...... ~...840 ...... Date ..................... Qc~ob~r...l~ ............, lf~.0.. · '
THIS CF~RTIFN~S that the building located afCO~...
_Map 1~6~. o..O..e... ~Y...~- g~ck No. *.~.~ ............. Lot No ....... ..1.~,.8.~.~..~ ......................................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ................. t~i~,.t~..14 ......... 19.~0.. pursuant to which Building Permit No...Z...i.0~ .......
~lated ................. Ap~.ll,..&4 .......... , 19..60., 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
.......................................................................... PJR.L3/A~I~...01~.. ~IIaY., .DICIgI~XI~G ..............................
This certifmale is issued to .l~,.l¢&nlii..G.,...tqllclcltelzr...ovra~l$ ............................................................
(owner, lessee or tenant)
of the aforesaid building.
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFF~CE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? i037 Z
Permission is hereby granted to:
K~asneski .&..~w. ll....~.C..~.a~..~urtdle~ .............
........ .S~U.th~td.....N.X. ...................................
to. BnJ~,~t .. ~J~.. ad .~.i ~ion.. on.. ~..e;~X ~.~i~g...d.,~ll;[~g ....................................................... ,
of premises located at ....~.O.~...~J~j~...~ ..... .~.~t~.....~OO~®..~t..'~:~-~ ............................ I. J' .......
.................................. ~.~;ne.. &.. O~k.. AVe ......... $O~ti~ol~l ,..... ~. ~.~ ......... ;....:'..... i.:..., ............. , .....
pursuant to application dated ................................ .~jJ~.~....;.~ ....... ]..]9~0.., and apprqvbd by the
Building Inspector . ''
ouilding Inspector
GOOSE CREEK
FOUND
S 86° 08' 30"E
.7'
STORY --
RES,
:27 JUNE 1989
CURB
N86°OB'DO'W 60'
OAK AVE~IUE
3(28'
94. 17'
MON
FOUND
SURVEY OF
LOTS 168- 1-71 INCL.
MAP QF GOOSE BAY ESTATES
AT SOUTHOLD
SITUATE
SOUTHOLD, TOWN QF SOUTHOLD
SUFFOLK COUNTY, NY
FM. 1176
FILED NOV. 18, 1934
SURVEYED 27 JUNE 1989
SC4LE I "= 30'
SURVEYED FOR
ROBERT R. WIECZOREK
RIT/I REIS WIECZOREK
GUARANTEED TO
ROBERT R WIECZOREK
RITA REIS WIECZOREK
AMERICAN TITLE INSURANCE CO
ATLANTIC LIBERTY SAVINGS BANK
TOWN OF SOUTHOLD
Guarantees indlcated here on shall
only to ~hc persoH for wh~rn the su~e~
is prepared, and on fli= behalf to the
to the assignees of the lend~g institution,
addif~aj ~sh~utions or ~ubsequent
SURVEYED BY
STANLEY J ISAKSEN, ,.IR,
P 0 BOX 294
.NEW 4~UFFOLK, N Y, 119 DE, //'1
Copies of
. , ~2~Y.S L~CL~O
Unc~utherized .alteration or addit~o, to
~urvey i~ a v~olatien of $.ctio, 7209 o~
the New Yor~ State Education
,I
89 R 418
FOKM NO. 1
Approved .................................... ,
TOWN OF $OUTHOLD
BUILDING D.EPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No.....J....O..~...~. ..............
APPLICATION FOR BUILDING PERMIT
Date ....................... ~,~...../. .......... , 19~:4~..
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 o detailed description of layout of property must be drown on the diagram which is port 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 ava.liable 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 Lows, Ordinances or
Regulations for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply w th all appl cable laws, ordinances and regulations.
....... ........ : ...............
~ ~ignature of applicant, or no~e, if a corporation)
.... ................................
(Address of app~nt)
State whether applicant is owne~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......................................................... .......................................................................................................
Name of owner of premises ......... ~Z~.~.~......~/~,~.~.,~,~, ~, .......................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of [and on which proposed work will be done. Mop No:, :~..~-;. .(./. .... Lot No: .../..
Street and Number ..... ...... . ..........
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. rx~sring use aha occupancy ....... ~,<~::,,<v,..-rz.~-~.~.....~',~..:.:': ...... 7¢_ ............ :~ ...... ....................... ~ ............................
b. Intended use and occupancy .........................................................................................
3. Nature of work (check which applicable): New Buildin,cl .................... Addition .......... ~.Alteraflon ...................
Repcdr .................... Removal .................... Demolition ................... Other Work (Describe) ....................
...... /, o0 ----
4. =st mated L. osr .............. ;~. ......... : ................................. roe .......... ~ ............................................................................
(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 ............... /.....~...-O.<'.~ .~...~.~..Z,~.-~...;~L:~:..~.~ ......................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................................
7. D,mens,ons of ex,st,rig structures, ,f any: Front ......... .~...~.... Rear ................':~'.~r,. Depth ........
'gh ............................ Numb r f S ' ./. ............ ~ .............................................................................. : ....
He t e o tar es ,:_...~:..~
Dimensions of same structure with alterations or additions: Front .......... ~!.../. ......... Rear .......... . .~..,,.'~...( ........
Depth ......... :'~..~..,f. .......... Height ............................... Number of Stories ............/......~ .....
8. Dimensions of entire new construction: Front' ..... ~.~. .............. Rear .......... ~_[~). ........ Depth ........ /...~ ......
Height ............................ Number of Stories .......,..~ ................
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 l. Zone or use district in which premises ore situated ................./.7...../.(~,~_.....-:?.~'~;~.
12. Does proposed construct on v o ate any zoning, aY6 ordir~nce or regu of on2 .~.~
,. .......................
-....
Name of Architect ...... ~ ................... ~.... ......... ~ ........ ~,.Address ..... ......~. ........ ::..;i,,.,,~.. .... PK~ne NO ........ ~ ............
Name of Contractor,~,z'.~,/~.-Z<-:.::..~.~-....~....~.(~t;~,c..~.f~/~ddrej-~..~f;z?.::.~..~;.'~:.~.,2f~.~Phone NO ....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensians from
whetherPr°perty interiorlines' GiVeor cornerStreet andlot, block numbers or description according to deed, ond show street names and lindicate
STATE OF NEW~'gR~x~ ) S S
COUNTY OF ~..~ff....) ' '
............... ' ............ ~...~.g. 5~.'..~.::~):~.~....:.t.~ ................. being duiv sworn~ depose~ end s~vs thor he is the ~pplicont
(Name of individual signing application)
above named. He is the ..................... .~'K~f~ ..................................................................................................
(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 an belief;
and that the work w I be perfarmed in the m~u~t fpr~..in the app cat on f ed therew th
bworn fo beTor¢ m~ u.~
.......... ~....~.. day of .................
FOP.,~ NO. !
Examined ...........(].~ ....... I. ....... ,
Approved .................................... ,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOU'mO:D, N. Y.
19.....?..Permit No.......'~...,.(..~..~..'Z ......
Application No, ....!..?....~...'..~. ..............
Disapproved a/c ...... ~... __~
........................ .............. ..........................
(Building Inspector)~
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 o 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 ava,liable for inspection throughout the progress of the work.
e. No building shall be occupied or used in whol~ 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 laws, ordinances and regulations.
(Address of appfic'ant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate, officer)
1. Location of land on which proposed work wdl be done. Map No .................. ~t ................ Lot No: ..............
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of prgpo?ed construction:
use and occupancy .................................................................................... ~..~,~,~.. ,~ ......
b.
Intended
3. Nature of work (check which applicable): New Building .................... Addition ......... ~ ./~........AIteration ....................
Repair ............ R~moval ............ Demo ition .................... Other Work (Describe) . .
'~' ~ ~' ---'~O ..................
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 Z ~:~ .~.~.<z~ ......................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................
' '
7. D~mensions of existing structures, if any: Front ............... Rear .............. ~.. Depth ........ ~ ...................
Height ............................ Number of Stories .~ ............. ~ ~ ..................................................................................
D mens OhS of same structure w th a terat ons or add tons Front ...~...~ ....... Rear .......... ~ ...........
Depth ......... ~..~ .............. Height ............................... Number of Stories ...........~.....~ .....
8. Dimensions of entire new construction: Front ..... ~ .............. Rear .......... ~.~. ........ Depth ........ .~.~ ......
Height ............................ Number of Stories ....... ~ ................
9. Size of lot: Front ............................ Rear ............................ Depth ............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
] 1. Zone or use district in which promises ~re situated ................. ~...~;~..~ ~..- .......................................
12. Does proposed construction v o ato ~n~ zonin~ la~, ordi~nce or renu qt on? ........ ~ .....................
· ' ................
13. Name of Owner of premise~;¢~.,~.'~~..~.~.,c P~ne ,O .....................
"am ' Ar h'e t ' -"res~--~z~-&~' ' ~
o, .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail 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 NE )
COUNTY OF~~.) ' ' ,. / I
... ,~e_~....~~~ ................ being c~lly swork, depose 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 and to make and file
this application; that oll statements contained i~i~tl~is applicati0mare true to the best of his knowledge and belief;
and that the work will be performed in the manner set forth in the ~jSp[i¢~tion filed therewith.
Sworn to before me this ,~0
~..,~...,..~.. day of ................. ~.~¢~'. ...... 19.~...~..