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Home My WebLink About1495-zFOEM NO. 4 TOWN OF SGUTHOLD BUtLDiBIG DEPARTMEBIT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... Z120S ............ Dote ............................ Ja. naary .......8", 19'6'~" THIS CERTIFIES thor the building located at .~lt~..P~..&..C~,I'I.(.~,~'...~,. .......................Street Deer Park Mop No ....................... Block No .....~ .......... Lot No. ~ ............ ]~,t~:J,t,~,OJ~t.....~j,.~.' ............... conforms substantially to the AppJicotion for Building Permit heretofore flied in this office dated ............................ ~'.1~1~. ....... 3-1 ................. 19.~]L.. pursuant to which Building Permit No...~...~O/~ dated ......................... ~'~ ' ' ' ' 3~' ........ , 19.6~.., was issued, and conforms to ali of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is .......... ............ P. ri~at e...oue..,fi.a~it~..~w~ lli~ .................................................................................. This certificate is issued to ..... ,.To~....J~a~ba3~.~ ................. Ow~ ................................................... (owner, lessee or tenant) of the ~foresaid building. ......... I~¥iding i~¥ector "i"j' ' FO~ TOWN O~,$O~VSO~ SUiLDING~ DEP~RTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1495 Z Dote ............................. Z.'aZ~.... 31 .......... Permission is hereby granted to: JO saph..D.eerko, ski.... A/~... J.o~.. ,.qambm~i ..... ................. ~a~ ~ i~t~ek ......................................... to .. B~ild.. ne~...one.. £amily....d~¢ml lir~ ................................................................................... at premises located at ..T.o~...~.~......~e~...P.~zc.k .................................................................................. ........................................ .C i~d~.. La ne.. &.. ~k.. Ro~ ~ ............ ~t ~f.t v~k ............................... pursuant to applicotion dated ................................. J.~.l{7 ......... .~1. ...... ~9.~1.., ond approved by the Building Inspector F~e $1.0.,..0...0. ........... FORI~/ NO. I TOWN OF SOUTHOLD - BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am~ned ....... ~ ......... ~. ................... 19 ~ !.. Approved ........................................ 19 ........ Perm t No. Disapproved a/c ..................................,,, ~.. ................ ~ .................................. · .................. .................................... (Building Insp~tor)-- ", Application No. /Cf ~.~ ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must ge 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 whi'ch 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 purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLiCATiON IS'HEREBY MADE to the Building Deportment for the issuanoe of a Building Permit pursuont 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 dem(~lition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name ~f a corporation) ............... tCuek ................ ?. ...................................... (Address of aR~,licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elect rician, plumber or builder. ........ ........... Name of owner of premises...~i'~'g~..~Jl~]ga~'.'l. ....................................................................... : ........................................... 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: ........ l~e'~.....POz~l~......y..!. Lot No: ..... 8 ............. 2. State existing use and occupancy of premises and intended use and occupancy of l~'roposed cohstruction: 3. Nature of work (check which applicable): New Building ........ l ....... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... ~.~i~.QO...P/]~[ ........................... Fee ........... ~01.O0. .................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ P~e ............. Number of dwelling units on each floor ............................ If garage, number of cars .........O~.e ............................................................................................................................ 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 ............. ~'6 .......... Rear ....... '~6 ................ Depth .............. ..~ ........ Height ............................ Number of Stories ...~i~ ................. 9. Size of lot: Front .........~1.,~.(~ ........... Rear ............ ~,~.0~ ......... Depth ....... Z.~) ......... 10. Date of Purchase ...........~,.~.6*1 ................................... Name of Former Owner ...... ~.~..,])~m~C~Otltr~, ..................... 11. Zoqe or use district in which premises are situated ........ tt~..~:~ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ 1~,~ ................................... 13. Name of Owner of premises....~.,...~l~l~,~'J. ........... Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ....... ~',~...]~.1~.~ ................ Address ..: ........... ~,~.~;~l,.~l,~i~.. ....... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property ines, Give street and block numbers or description according to deed, and show street names and indicate whether int~erior or corner lot. STATE OF NEW YORK. COUNTY OF ........ SS. .................................... ~.¢l~.~l,....~f~.~o~. ................... being duly sworn, deposes and soy: that he is the applicant (Name of individual signing application) abow~ named. He is the .............. OO~'i;;~&O.~,O;~. ....... ..),;.....~.,.,.~. ....... ...,: .....~, ................ : ......................................... ' ~ ,/(Contractor, agent, corlborate officer, etc.) of said owner or owners, and is duly authorized ~ perform or have performed the said~ work and to make and file this application; that ali statements contained in 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 th,erewith. Sworn to before me this JUDI~}t ¥, I~OKEN ' ................. · ,~Z.. day_of, , ._._~z, ) /~ ,,~:~.¢,,s.~l.~..~r~2~;~i~c,~ci~-~,~oNe~ ¥orl~ ~ (Sionotur~ of applicant)