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Home My WebLink About4591-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~331+ Date .. ,.Tll]~ 30 , 19 .73 THIS CERTIFIES that the building located at ]~/S Oakiawn A~ro E~ Street MapNo. ~ BlockNo. ~ . ..LotNo.~ ..S~O~ ~,Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated Dee ~ , 1969 pursuant to which Building Permit No. b~gJZ dated . .Do~ . iS... , 19 69 , was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~va~ ~e f~mtly, awel~g ................... The certificate is issued to P~te~ ~og~&~. ·. ~e~ .. (owner, lessee or tenant of the aforesaid building. Suffolk County Department of Health Approval UNDEP, WRITERS CERTIFICATE No Per~cl~'tg ¥365 .Street. 0~.I.~MI:I. AVa .g~.~ ....... Budding ]llspcc [Ol FORH NO. ~ 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 ^UTHORIZED) Building Inspector. TOWN OF SOUTHOLD BUILDING DE PAIKTMENT/7/~,>y~,,~ TOWN G'~iRK'S OFFICE .~OUll,IOLO, N:Y. INSTRUC'rlONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building I nSp~Ctor. b. PIo. t .pi.an sho. w!n.q I.oc.ation. of. lot ,a,nd of.buildings .on pre.m!ses: relations.hip to adjoining premiees or public streets or areas, ana g,vJng a ama.ea aescr,pTion or ,m/out or property must De arawn on the diagram which is part of thie 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 sh~ll 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. ^PPLIC~TION IS HEREBY MADE to the Building Departmer~t for .the issuance of a Buildi.ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk C~unty, New York, and other apphcable Laws, Ordinances or ~.egulati.o. ns, .for the constructi,on of buildings, additions or atterations, or for removal or demo t on, as herein described. ne app.canr agrees to compw with all applicable laws, ordinances, bujlcling code, housing code, and regulations. (Signature of al~Jcont, or name, if a corporation) (Address of applicbnt) ~' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... .................... . ............ Name of owner of premises ....... .~...~..~..~..~.. ......... .~.....~.~. ~...~.:....c~.. .................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which prop°~ed work will be done. Map No.: ............... ~ ................. Lot No.: .. ...................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ......... .,~...~d~_~. ~ ................................................................... ?. (B' '-uilcling(Inspect' or) · APPLICATION FOR BUILDING PIBMI'T ,, 3. Nature of work (check which applicable): New,Building ................... Addition..................~ Alteration ....... ~..:....~J~ Repair .................. R~mova ............... Demo t on Other.Work (Descr be) moted Cost ...... ....... i ......... Fee. ........ ........................................................................ ' m (to be paid on filing this application) If dwelling, number of dwelling units .......... Z ............. Number of dwelling units on each floor ....... Z ............... 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 ..,4~i~..... 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 ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ...... ./..~..'~...,~....O..../9,/_~;~Rear ............ ./.~..*..~.. ..... Depth ...?.~'.~...~_~__ 10. Date of Purchase ..................,..,c...~..~... ....................... Name of FormerOwner ................... '~-'.-..~.~c.~..~-~,~"'~'//- ............. 11. Zone or use district in which premises are situated ............... ~ ...... .......................................................................... 12. Do;s proposed construction violate any zoni,ng law, ordinance or regulation? ..... ~.. ............................................ 13.' Name of Owner of premises ...~.~..~...~..~'/....~-~... ........ Address ....~....~..../~.x~.~s~. CY-.~.~. Phone No ~..~ ./~.-~1 Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... .-~...;..~../'~.... ......................... Address ............................................ Phone No ..................... PLOT DIAGRAM Loca~t clearly and distinctly all buildings, whether existing or prOPosed, and indicate all set-bock dimensions from prOPerty lines. Give street and block number or de~ accordin_g to~ deed, and show street names and indicate whether int.erior or comer.lot. ~';~'~/~ m,2.~' x'~ ~,--- ~/ I STATE OF NIDW YORK, // tee e (o ' ' COUNTY OF .... ,~,c~¢.~. ,1~--,-~/~'.. ".)' "" ,__.-- - (Nome of individual signing application) above named. He is theL.~ ....... ~.~.~.~.~ ................................................................. ; ....................................................... (Contractor, agent, co,rate 0~cer, etc.) of said owner or owners, and is duly authorized to peHorm or have Rerfo~ed the said work and -to ~ke ~d file this application; that all statements contained in this applicati~ are t~e to the best of his knowledge and belief; and that the work will be performed in the' manner set fo~h in the applicati~' filed ther~ith. Swo~re methis ~ ................ day of~ --~~ ........... , 19.~.~: .............. .~.._~.....____ ,~ ~.~ ~ota, ~ublic, . ........... ~.. ~~ ................... Coun~ {Si~ n~ture ~{'eppllcant) ALBIN JANUICK Residin~ in Suffolk Coun~ ~ ~mmission Expires March 3~, Ig~