The URL can be used to link to this page

Home My WebLink About1576-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No... ~1,1.~ ~J~J. ............. Date ............................ THIS CERTIFIES that the building located at .~/~-.~t141~..&~ .................................. Street Map No....~J:J[~ ..........Block No. ~ .............. Lot No .......~ ...... ~IJjJ~I~IF..JJ,.~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................................... J)J~;JlJl~lJJl~..~ .... 19~... pursuant to which Building Permit No. Jl:'~ .... dated ...................... ~)l~.~,l:l~[~J'.....~....., 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 .......... ...... ~.~...~n~ .. ~.ol lz .~w~llJ~ ........................................................................................ This certificate is issued to .~llll.~l..~'~JjJl~ ...... JJJfflOJ~ (owner, lessee or tenant) of the a,foresaid building. ll.D.Approval O~ne 8, *62 - Ma~kovsk! FOItM 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) N.° 1576 z Date ........................ 0¢~;O~.....6 ..........19.61.. Permission is hereby granted to: ..... ~u.t ~...~,~eTt: ........................................... .......... ~-~'...enpor. t ................................................ to ..... ~ · .n~w.. on~ · · £~tl.~ · · ~we.l.l..:}~n~ ................................................................................. at premises located at .....'~',~-~.....C~.d~I't..AI'~...,(,T,,.~I~.).....(Goo~e...~8,.~) ...................................... .......................................................... 8~u.thold ................................................................................... pursuant to application dated ............................. ~to~M~'.....6 ...........19.6~.., and approved by the Building ~nspector Fee $.10.,~(~0 ........... ........... ...~..L-~...?..~ ............... ........ ~....~ ...... ~'~ilding Inspector '~ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. i: ............ : .......... 19.. Approved ........................................ , 19 ........ Permit No. : .............. Disapproved a/c ...................................... ~ ................... > ......... ..~. ........ (Building Inspector) Application No. / .......................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submit~te~d in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinin~ premises ar public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram w.h, ich is part of this application. c. The work covered by this application may not be commenced before issuance of Bu!lding Permit. d. Upon approval of this application, the Building Inspector will issue a Building ~>ermit to the .applicant. Such permit shall be kept on the premises available for inspection throughout the progress o'f the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. ' APPLICATION IS H'EREBY MADE to the Building Department for the issuance of o B~ilding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app, licable Lawsr Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or ~erd~olition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ~ ' (Sign.ature of applicant, or'name, if a corporation) -~/~aaress at ~ppncant) State whether applic~ant is owner, lessee, agent, architect, engineer, general contractor, electrician plumber or builder. If applicant is o corporate, signature of duly authorized officer· , (Name and title of corporate officer) 1. kac~tion e{ land on whlch proposed work will be done. Map ~ ................... .~ ............ ::.....~. ~ot No:j~,~ ............ 2. State existing use and occupancy of premises and intended use end occupancy of proposed ~onstruction: a. Existing use and occupancy .~,~Ot~.B.~...[e,~0 ................................................. f ........................ : ............................. b. Intended use and occupancYO~O.~.~.~r. ~ z 2.1,~.~ · 3. Nature of work (check which applicable): New Building ....~ ....... Addition .................. Alteration .................. Repair .................... Removal .................... Demolitior~ .................... Other Work (Describe) ........................ 4. Estimated Cost .2)*.,.Q0.0...~./.~ .................................. Fee .....Z. 0.:O..0 .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........~l ............ Number of dwelling units on each floor ............................ tf garage, number of cars ....... .~.'vlD ............................................................................................................................... 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 alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~.~.t.~...~. .............. Rear ...... ~.~.. ................. Depth .....,,~ .................. Height ............................ Number of Stories...~l~L~..~..~,~f~l,~ 9. Size of lot: Front ....~,i~9. .................... Rear ........ ,,~. ............ Depth ......... '1~'.0. ....................... 10. Dote of Purchase ............'196,1. .................................. Name of Former Owner .......~..,J~O}~,~. ...................... 11. Zone or use district in which premises ore situated ....... ~lJ!..~e.~..&..~..a.~.&~ ................................................. · 12. Does: proposed construction violate any zoning law, ordinance or regulation? .......... 1'~ ....................................... 13. Name of Owner of premises .~.&..Ji~O~e~.~ ....... Address .......... I~.e~'.~, ............ Phone No ..................... Name of Architect ...~,~BJI:~..¥1M~.~.Z.i .......... Address ................................ ! ........... Phone No ..................... ..... ~. ~.'.~11~01'.~ ........ i ........ Phone No ..................... Name of Contractor ' ' 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 NEW YORK, ) COUNTY OF ....J~,~/'.o~Lk ...... ) S:S' ................................ Lo~l,~...J(o~'.e~ ................................. being duly sworn, deposes and s6ys that he is the applicant (Name of individual signing application) ~/ above named. He is the .............. ; ....... .~/i~[' ....................................... ................................. ~ ................... ........................... ('Contractor, agent, corporate officer, etc ) of said owner or owner~, and is duly authorized to perform or have performed the sai4/work and to make and file this application; that all statements contained in this application are true to the best of his knqwledge and belief; and that the work will be performed in the manner Se~u~itJ~tb, i~J0~[J~e application filed therewith. Sworn to I~efore me this ' ' ~rot~r~, Public, St"a't, of New York ~ ~..-.~ ,"~ ' ~'~ I~ ,, ~"l..-~,~,~ ,,u 52-0344~, Suffolk County , ~. '"-,,~.,,~-/-/-~ ~ ' //- · ................... .'?.... day of ............. :.'f~..".~.."..~.*....v.....~..~0?lsg,.~.~?s r~roh 3O, ~ ,~' ~ /~ · ', .*~-...., ~,/ ~/ / //..4/ .................... /*'-7' .................... /. ............ ; .................. : ......... Notary Pub lc, .....,/~.,,~,/~..~ .ff~.~..,~,:,,~..,?~,~/~.:'~.:~'.,~,...."~,t~,~e ( 'gna U~'e of applicant) / YALLEY NATIONAL BANK June 7, 1962 Mr. Howard Terry, Building Inspector Southold Town Hall $outhold, L.I., N.Y. Dear Mr. Terry: Mr. Chet Orlowski asked me to forward the enclosed "Certificate of Bacteriological Analysis" to you. I believe he dropped off the building permit today. I would appreciate your at your earliest convenience. velope is enclosed. issuing an Occupancy Certificate A self addressed stamped eh- Should it be necessary for you to contact me, the Bank number is Gr-7-1700 and home Gr-7171~. Many thanks. Sincerely Louis Komar ek Vice-President LK:gs eno. ,0 '0 /' /'/ // /'' /, .,V,' / \ 1 \, \ x \ x .. ~c&Le- %" & I_ilX.i:... ii .... l__ o t'l ,gca. Le. I/~t'D~ /'a" Zcate- '5" t* I'o"