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Home My WebLink About4286-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...... ya. ct,~rT..,A~ ..................................... Street Map No. '"x~c .............Block No .....~ ............ Lot N0.~XX.....j~/c~,~tC~.....~q.,.y.~ ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ ~ ...... ~ ....................... , 19..6c). pursuant to which Building Permit No.J~2~ ..... dated ..................... ~tJ~f ......... 1'.~ ............. , 19...6~), was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............... Pr~:v~t ~"o~e'"~am ~'1~" d~e ~'~r~ .................................................................................. The certificate is issued to '~'~'"~'a.~:OWS~:~"~Z' .......... ~';~vn(~r,~j~;'~;,"~'~i .............................. of the aforesaid building. ~ouse ~ 101~ FORM 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: AUTHORIZED) N? 286 Z Permission is hereby granted to: at premises located at ........................ ll~....~l~t~..d~,'~ ............................................................. ....................................................... Iintt~.t~ll ...... ~.Z. .................................................................. pursuant to application dated ............................... ~ ........$~, ......... , 19..~1~, and approved by the Building Inspector. Fee $ ..................... Disapproved a/c ............ (Building I~pec~' ~' ................ APPLICATI(~N FOR BUILDING PERMIT Date ............... . .1~.~'.... J.3 ........19.69 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building InspecWr. b. Plot plan showing location of lot and .of buildings o n premises, relatim~hip to adjoining premises or public streets or areas, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may r~ot be commenced before issuaflce of Building Permit. d. Upon approval of this application, the Building In spector 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 o~ in part f~' any purpose whatever until a Certificate of Occupancy shah l~ave been granted by the Building Inspectg)e. APPLICATION IS HERI~RY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soathold, Suffolk Oounty, New York, and other applicable Laws, Ordinances ,or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as harein described. The applicant agrees to com ply with all applicable laws, ordinances, building cede, housing code, and regulations. ~rs Wm Jakowski Jr (Signature of .applicant, or name if a corporation) ..... lqattituok. · .N ,.Y., ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................ & I~eKl~ .o f..ol/Ilel' ................................................................. Name ,of owner of premises ........ ~m~..Jakol/~qk;L .St ................................................... ~ If applicant is a corporate, signature of duly authorize d o/ricer. ~ (Name and title of corporate officer) ~ 1. Location of land on which proposed work will be done. Map No..lr~ ............ Lot No. XX ......... ~ ............ F~eto~y. Ave .... ~/at. tituck. .................................... Street and Number ~> ! ~ /~/__q- Municipality State existing use and occupancy ,of premises an d intended use and occupancy of proposed construction. a. Existing use and occupancy .... ~llg.~l,~Ili[ ..................................................... b. Intended use and occupancy ..... S.$~e .~th. ~dditiml. an. fxont .poxc~ .................. 3. Nature of work (check which applicable): New Building ........ Addition ...x~.. Alteration .... ~.. Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost .... ~00, .~. .................... Fee . .~,.Q0 .......................................... (to be paid ~n filing this application) 5. If dwelling, number of dwelling units ...Oll~... Number of dwelling units on each floor .............. If garage, number ~f cars .......................................................................... 6. If business, commercial ~r 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 ...5 ............. Rear ... 5' ......... Depth . 6 ........ Height ............ Number ~f Stories ... ~115 ...................................................... Size of ]~: Front ................ Rear ....... ~. ~ ..... Depth ............... Date of Purchase ............................... Name qf Former Owner ............................. Zone ~r use district in which premises are situated ....... .~A.~. ~lS.t .................................. Does proposed construction violate any ~ning law, ordinance or regulation? . .~1~ ..................... Name of Owner of premises .~/m. ~'ak~w~k~. ~1'. - -~ddress .... l~t-~-~lek ...... Phone No ............ Name of Architect ............................. A'ddress ...................... Phone No ............ I~ame ~f Con~ractor ...S~le .................... Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimens$ons from ly~perty lines. Give s~eet ~nd block number or de scription aceerding to deed, and show 's~reet names and indicate whether interio~ or co, er lot. . 10. 11. 12. 13. STATE OF 1~ YORK, )S.S. COUNTY OF ~%Lff. o~¥ .... ) ............. ]~s .Wm.. J[ak~sk~ .Jr. .............. being duly sworn, deposes and says that he is the appli- (Name of individual signing application) cant above named. He is the ....... :. &g~nt. ~f. ~¥ne~ ................................................ (C~ontractor, agent, corporate officer, etc.) of said owner ~r owners, and is duly authc~cized 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 w~rk will be perf~n~ed in the mann er set fort~ in the application filed therewith. Sworn to before me this "'"'"'"" ' r''--'''-'~.' I~OTARY PLIBL~C, ~J~ate o! N~oV~ Yem , No. 52.8Z2~850, Suffolk oqA~l T~rm Expires ~ ~O, ~.~