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Home My WebLink About4122-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy No. Z .3708 .... Date ............. ~)eO ..... ~-9.., 19..69 THIS CERTIFIES that the building located at ...E/~..Wl0~'l~. AVe ...... Street Map No. l~;.t .HTS.. · Block No .......... Lot No. 1~ .~S.t.l~. &]~. · · l~ttttuck...~¢,¥, conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l~o~ ..... 12..., 19.68 pursuant to which Building Permit No..1~]~2. Z dated ......... l~ov...l~.. , 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 ... ~x~iva.te. one .family. clwellin{~ .................................... The certificate is issued to .Frank.Nowak ........... ~er- ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approva! . .De~ .i~2-..~ 96~.. Ivy. -R,. ~/.~.lla .... x .Building Inspector FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE $OUTHOLD, N. Y. N9 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~:122 Z Dote ........................................................ , Permission is hereby granted to: ~_ . ..... ,,, ~.w ............... ~ ............... '~ ................................... .~ .... ....................... ;;..;;. ............................................ i ;';;,,-'~ ~'~,~;~-~-, ~:--. .... ~ ,_ t. .-- . .: ..................................................................... at premises located at ..................................................... t~"t /-~ ,! J I ~.~ I.~. .................................... / 0 ~,' -/~/ ~pproved by the pursuon,t fo opplicotion d~ted ....................... ~..-:,' ............................... ' Building Inspector. !(; Fee $ ........................ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~/~'~ ? ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) : ,. have been inspected by this department and found to be satisfactory. District ~ngineer District Engineer ? % -4 , .~ (i 2'2 FORM NO. 1 TOWN OF SOUTHOLD : BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. Application No. ~/~'~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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, r~elationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which s port 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 o 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 HFREBY 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, Nlew 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~;llli::~egula~ ~ 'g~ pp' , oma, if a corporo~[~¥ ........ ............... ...... (Addre~ of applicant) ~, State whether applicant is owner, lessee, agent, architect, engin~r, general contractor, electrician, plumber or builder, ................ Name of owner of premises ............ ~.~..,.,.~.~..~..~.,~. ................................................................................. If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) ..d .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................... ~.~..~.~ ................................................................................... b. Intended use and occupancy .................. ~. ............................................................................................ ....... ,, ,cnecK which applicable): New Building ...... ~..." ..... Addition .................. Alteration .*..~,...?..'..~ ...... Repair ............... .¢ Removal ...... ~, ........ Demolition .................. Other Work (Describe) ........................................ .4.. Est ,-,,,,:,ted Cast :. ......... Fee '. ...................................................... (to be paid on filing this application) 5, If dwelling, number of dwelling units ............ ~. ............. 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 e,lterations or additions: Front ................... .~.. .............. Rear .......... ,,~, ............... ~ ,.'~... N b fsi Depth ................................ Height ....................... urn er o aries ................................ 8. Dimensions o~,~ ~,~entire new construction: Front ...... .~.~,~,,...../.~..../.~.~.,.. Rear ..~,.~.../...~.~..f.5 ..... Depth ..~...~.....1~......~../.~,/ Height ...,~.~..,~..., Number of Stories ............ ~ ........ ,~ ............................................................................................ 9. Size of lot: Front ..... /.~I..~..,,~..Z., Rear ..... W~,,.,~.,,.,¢~..... ...... Depth ....... ZZ.~....~., .~..,., 10. Date of Purchase ~,..~., ./.~.-~, ~.~. ..... Ne-ne of Former Owner ....... (~"].,~../~..¢~,../..~'~'.~. .. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .............................................. ~ ............ 13. Nome of Owner of premises .~./,?,~.,.~....~.......~.O..~...~./~.,,.,Address ./3,.,.~...~,_~...~...~[.~... ....... Phone No.~, .~.~..'..~, .~.~.. Nome of Architect/~.C~,Zq,~./~....,~...../~./~, ............. Address ~l~,,'..0.~.../..¢~,,~,,~',..~..~...~..8~.e.0....~l~hone Nome of Contractor..~.~..~..~....~...._,,/~...8...' .~....~.,./,.~. .......... Address ..~..~..I'~P¢.~'...~,,~.Z. ,~... .......... P'hone No, PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, STATE OF NEW YeORJ~, / S S COUNTY OF ..... .o...k~.C~I~E-,., ........ J' · · ........ · ~...~...~...~,~.~'...,,~....~..t~.I~.,~.,.L~ ............................... being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named, He is the ............. ~.~.~.~,~.~..~ ......................................................................................................... (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed' the said work and to make ~nd file this application; that oH 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 applicotion~d therewith. Sworn~.~..~... d~,, oft° before me this ....... ..... ......