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Home My WebLink About3159-zFORlV[ 1~0. 4 TOWN OF SOUTFIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. I~EI~TIFIP. AT£ elF' OP-CUPANP.¥ No. ~ .2~j~) .... Date ............ O(~6Ob~'' '~i~' .... , 19. ~ THIS CERTIFIES that the building located at .~ .~e&~l' '~k~e '~' 'PV~ .~treet Map No..~ ....... Block No. ~ ........ Lot No. XXy~ .... }]ou2hoffdy '~ ........ conforms substantially ~o the Applicati~on for Building Permit heretoSore fried in this office dated .............. ~Uly''" ~'~ 19. [~ p~rsuant to which Building Permit No..~.~. ~ dated ........... ~,~yj ....... ~ 19.~., was issued, and conforms to all of the require- ments .of the applicable provisions of the ~w. The .occupancy ~or which this certificate is issued is .. P;~lvate..ene. I'aml~- d~Jelilag ......................................... The certificate is issued ~o ~ . ,~ (own~71~ssee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... ~.~ ......................... FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BI: KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3159 Z Date ................................ ~'..~. ....... ~. ...... , 19...~.... Permission is hereby granted to: Geo~.l~a..i~r~..,l'~ ........................................... ....... ~ta~ea~.l.v~ ........................................... ............ ~o~t~o~l~...N..¥~ .................................. to .. i~l,~& ..a~..a~l~,it,~.e~..ea.. ea..~.s.t,$r~.. ~¢e~.t..~ ....................................................... at premises located at ..~.J~.....]J~:~lBlaalz..&~l~..~..J~oJ.e~'...[~l~,~-e ................................................. ......................................... 8ou,thold.~,..ll .¥. ....................................................................................... pursuant to application dated ................................. ~.~......~.~' ........ 19(~..., and approved by the Building Inspector Fee $...~...0~... ........... Building Inspector FOEM NOo l TOWN OF SOUTHOLD BUILDING DEPARTMENT ~OWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .. 'l ................... ' ........ Approved ........................................ , 19 ........ Permit No. 3Z...~.?.....~ ................................ ....................... ] ......... Application No. APPLICATION FOR BUILDING PERMIT Date July 1~' 66 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitied 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 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. George Barzac Jr (Signature of applicant, or name, if a corporation) .......... Bo£sae au..A~.~.....S.o.u.thold ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ............................................ .......................................................................................................................... '. .............. Name of owner of premises George Barzac Jr 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.: xxx Street and Number ....... ~/..f[....]~.q:i,~q.~.~..&~.~.~.....~.~.~.~q~.~...~.:..~..,. ............................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........ .o...l~..e....?...~..~..~...]:~...~e...~.~.i...~.~ ............................................................................. b. Intended use and occupancy ........... .~..~.~...e.......l~.]z..~.~.'~f~..~`.~.~.~.~...~..~.'.~.~.~.~.(.`~.~..`q.~'..~....g.~.~.~ .......................... 3. NatUre of work (check which applicable): New Building .................. Addition ....~ ....... Alteration .............. Rep,,ir .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Esti+ated Cost ...~.t.~30..~ ........................................ Fee ......... .~.,~0~ ................................................................... . (to be paid on filin§ this application) 5. If d~velling, number of dwelling units ........ P~I~ ............. Number of dwelling units on each floor ........................ If g~rage, number of cars .......................... t~.o ........................................................................................................ 6. If ,usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dir ensions of existing structures, if any: Front .......~. ................. Rear ............. .~r ............... Depth .....~0 ........... Hei~ Iht ........................ Number of Stories ..... ..o..~..e. ................................................................................................. Din'ensions of same structure with alterations or additions: Front .................................... Rear ........................ Del: th ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ,~.~ ....................... Rear ......... ~.~ .............. Depth ........ ..~..~. ...... Hei ht .................... Number of Stories .... ~ne ...................................................................................................... 9. Siz~ of lot: Front ......1.Q6/....~...0..0..O.. ~ear .................................... Depth ......1000...+. ............ 10. Dot of Purchase ........................................................ Name of Former Owner ................................................... 1 t. Tar ~ or use district in which premises are situated ........ !!~!...~,,t,.fLt ..................................................................... 12. Doe' proposed construction violate any zoning Iow, ordinance or regulation? .......... ~. ....................................... 13. Narhe of Owner of premises ...C~f~P..~a~'~fL¢...~.~......Address ..... ~D.ggg¢~],~ .................... Phone No Nar~e of Architect ...................................................... Address ............................................ Phone No ................ Na~e of Contractor ...~.,...]~dic~ ........................... Address .......... ~.O.~.~,b,O,~,0, ............... Phone No ................. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property I(nes. Give street and block number or description according to deed, and show street names and indic, whether in!erior or corner lot. ~[ STATE O[ NEW YORK, } ¢ ¢ COUNTY [OF ...... 8.uf£.c~ .........f '~'°' bein,~ duly sworn, deposes ,and says that he is the applic Gao Barzac Jr i(Name of individual signing application) above nar md. He is the ...............0.~t't~:~ ......................................................................................................................... of said ay this opplk that lhe w Sworn to ~ ...............Notary Publlc,~~......~......~..~.~ .~ounty'~'~'''' day of ...... L ......... '~'~!~"'";~ ............. ' 19'""6"6' /~/ MARION A. V NOTARY PUBLIC, State of Ne~ Yor~ NO. 52-3233120 Suffdk County Te[m Expires Msrch 30, lg~'7 (Contractor, agent, corporate officer, etc.) her or owners, and is duly authorized to perform or have performed the said work and to make and arian; that all statements contained in this application are true to the best of his knowledge and belief; ~rk will be performed Jn the manner set forth in the applicetion'.filed therewith. efore me this ~ of