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Home My WebLink About2671-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at l~=~c~ge .~rle,...=t~t~hOg. U~. ............... Street Map No ..X~ ............ Block No ..... ~ ..... Lot No ...... ,1{.;~ ............................................... conforms substanhally to the Apphcahon for Budding Permit heretofore filed m th~s office dated ............... .M~r~h..5 ............................. , 19.65... pursuant to which Building Permit No .~.~.7..~....~. dated ......... ~9,~b...~.7. ..................... , 196~. ..... was ,ssued, and conforms to all of the requirements of the applicable prows~ons of the law The occupancy for which th~s certificate ~s ~ssued is ........ .............................. .ne~w.. one. f~ily...~ell~ng ............................................................. The certificate is ~ssued to ..I:bat~.~..Zi~trtC~lsk;[ for M~'~e .~.n~.~tf.~..~f~.t,~,.~..e. ................... (owner, lessee or tenant) of the aforesaid budding I~OI~M~ HO. 2 TOWN OF $OUTHOLD BUILDING D£PARTMENT TO~NN CLERK'S OFFICE $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 2671 z Dote ~Z'e1~ ]-7 lf, 6~ Permission is hereby granted to: ........... .~..e...~ .............................................. ................ .~l~_.~_og~ ......................................... to. ~.. ~.e.~...o...n..?...~.~z...~.e.~. ~ ..................................................................................... pursuant to apphcatlon dated ................................... ~.~...~......~.. ...... 19...6.~.., ~nd appro~d by the Building Inspector Fee $...~...0.,...(~.. .......... Budding lnsp?tor I~RM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. " 2¢7/ Approved ........................................ , 19 ........ Permit No ................................. Application No, ,.~,..,,~.,.,~,.f,. APPLICATION FOR BUILDING PERMIT Date ......................... ~a~.ch.....~ ............... , 196 ~'. ...... 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 a detailed description of layout of propertymust 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 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 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, building code and regulations. ~ Zanowskl A/.¢...~lkc..Z~now. a~.1...Ea.ta.t.~ ........................................ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. ~.ge~.~.. o f...O.m~e,~ ...................................................................................................................... Nome of owner of premises ..M'~ ke...ze, no.w$~.i...~s.t~te ................................................................................................... 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: .............. ~ ...................... Lot No:Y-,,3~ .............. Street and Number ..~'/~..]~.~Lg~...Z~.?...~:/...~.,.~.t.~.,.~., .................................. ~......~ .............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~'.a~.l~..Eta,~_d...~,~..~.~ ............................................................................... b. Intended use and occupancy ...... D.e. I4...(].~.~,~.~D~ .............................................................................................. 3. Nature of work (check which applicable): New Building ...... ~{~.... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition ............. ; ...... Other Work (Describe) ...................................... ~4. Estimated Cost ........................................... ; ................ Fee ~..0.~.0.(~ ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...ol:le .................. 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 .......................... 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 ........ ~.~ ............... Rear ..... .bc~ .................. Depth ~..~..-.~R ................... Height ............................ Number of Stories ...... QrJ,e ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are s tuated.....~, ....... .C~,.~..~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~. ........................................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ' .................................................... Address ............................................ Phone No ..................... 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, ~ c ¢ COUNTY OF ..~'~l~..e, e3.t'' ............ ~ '~'°' ,~'~(~4~.~. being duly sworn, deposes and says that he is the applicant ...........(Name~/of/-~dividual signing application) above named. He is the ...... ng~Z~...O£...O.'~De,~. ................................................................................................................. (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 and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... dayof .......... .................. (/ Com~s~ ~1 E:.:~,~s ~,~rch 30, 1~ .~ 0 ra~.~