The URL can be used to link to this page

Home My WebLink About2854-zFORM NO.~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...ISland .VieW. La~ ...... Street Map No. ~ .......... Block No. ;X~ ....... Lot No. x,~... Gl~®en~ol'l;.. lq ,~- ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 'Sept; "3'" 19.6~. pursuant to which Building Permit No.2[~Z... dated ......... ~P$" '3 ..... , 19.6~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pr:l..v~te..o~e.-~a~i-17 -~lwe~.lLng ...................................... The certificate is issued to . JalS~S .Bol~d&re~i~k. ...... O~.ller ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Dee..1 ,..¶.971. ~ .~1o..~il~.a ...... Building Inspector FORcM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 285 z Date ............................... Sep~,,el~beF......~ 19....(~' Permission is hereby granted to: ~s..,Bm'lcl. er~huaic ...................................... ............ ~se$~o~ ......... ~.~ ............................. to ....... B~t.l~.. ~ew.. one ..£etWl. lF .-dwe']'t~ ................................................................................ Gt premises located at ...... ~/8.....Ze, l. at~d...~t.ew...l~a,ne.....{..Wie!eham.-t~at,~.} .......................... pursuont to application dated .......................... ~pt, elal;~l~ ....... ..~ .... 19..~,~., and approved by the Building Inspector Fee $..ZO,O~ ......... -- Building I~pector 'J .... SCltD ,', ' ,~ ~' ....! ' :, SUFFOLK COUNTY DEPART NT'0F .HEA TH ' a .Dece r 1 , ' Ddt , ' BI~ rm 2854Z . ' .... . , g., P~ i~ No.' , ~ ' The' sewaga disposal' ~ac~lities, for 'a ~t ~ '~ , ~ Island View Lane, Gre~nport,~ N.'Y.' "' :, , ~ , , ~. , ,~,, " (Civ~ "de'ed.. loca~i°n) have been inmpgcted,'bY this depa~tmant';a.d' f0u'nd, go be FOE, M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT i~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned ........... .'~....../ ............. .L....., 19.. Approved 19...: .... Permit No. ~;m~') Disapproved a/c ................ ,; ......... ;;:';L.J~.~/ ......................................................... Application No.~.~ ...... ~../~ ............... (Building Ins~~) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application mus{ be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. , , b. Plot plan sha'wing Ioc~tion of lot and of buildings on premises, relationship to od Dining premises or public streets or ereas, and giving a deta led description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by !this application may not be commenced before issuance of Building Permit. d. Upon approval of thi~ 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 Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of ~tbe Town of Southold, Suffolk Count*/, New York, and other applicable Laws, Ordinances or Regulations, for the construdtlon of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to come,ply with all applicable laws, ordinances, building code and regulations. .... .,Tame ~. · .B~nC%e~oh:t~ .................................................... (Signature of applicant, or name, if a corporation) ........... *'~tl,1.....Ja,,nsesel~, Ave .... R.. -~img,ton..P.&, ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................... O~'~er '"' '.~' 'bu:t.lcl~ .......................................................................................... Name of owner of premises .....~:i~.Tae~...l~.otl~el,.~il~htl(I]~ ..................................................................................................... If applicant is a corporate, signature of du~y authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done..Map No.' ....... '~i~t~:~..~.~.]~... Lot No.: ...;~,,~. ............. Street and Number .,.~'/~.-..Is.~.~t~..¥iel~/...~l~e ............ G~ee~o.~.~,~...?o.~'.. ................................................ ~unicipality 2. State ~xisting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~'~(~,~,~..~..~. ............................................................................................. b. Intended use and occupancy ........... O~,e...£~.~...~.~e.].].:~T~ ........................................................................ 3. Nature of Work (check which applicable): New Building ....~.. Addition .................. Alteration Repai? .................. Removal .................. Demolition .................. Other Work (Describe) !,, : ,, (to be paid on filing this application) 5. if dw,Je[Jing, "number of dwelling units ......... .~ll~ ........... Number of dwelling units on each floor if ga!age, number of cars 6. If bdsiness, 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 Dime~nsions of same structure with alterations or additions: Front .................................... Rear Dept~ ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .36 ..................... Rear ..... .~..' ................ Depth ....... ~. ......... Heig[?t .................... Number of Stories ..... 10. Date: of' Purchase ...................... ],~J~,,~ ........................ Name of Former Owner ..... ~e~.~...W.~ll~l~.e. ............. 11. Zone/ or,use district in which premises are situated .....~.~......~-~.~ .............. 12. Doeslproposed construction violate any zoning law, ordinance or regulation? ....... Namle of/Architect ..~ .............. ; .................................... Address ............................................ Phone No. Nam'e of 'Contractor ........... ~lllf~. ............................... Address ............................................ Phone No. PLOT DIAGRAM " Locate' dlearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property limes. Gi.ve street and block number or description according to deed, and show street names and whether intJerior o~ corner I,ot. STATE O~, NEW YORK, 1 o ~ COUNTY IOF ..~,~'~ ............ j- ~.o. ................ · ~ .............. ~'~.~el~...]B~lel~ti~Jl:. ........................ being duly sworn, deposes and soys that he is the i(Name of individual signing application) abow~ named. He is the ............ ~'.~1l~'...?...~.~::[~¢1,~. .... (Contractor, agent, corporate officer, etc.) of soid o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this applisation that all statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in the manner set forth in the application filed therewith. Sworn to ISefore me this , ,, ..... ................. .......... N ora ry Publ ic,~..~. '/...~¢~..~;'~ .¢ ........ .c:.C:..../../-~i~. ^ .CR~R E~:~ ~ (Signature of applicant) ~ / ~OTARYbPUBLJC State 01 New YorX , ' NO. 52-32331~0 SufloJk Term Expires I~arch