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Home My WebLink About4349-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No..~.~ .... Date ............... ~.. ~., 19. ~ THIS CERTIFIES that the building located at . .]~ .~.~. ~k' ~' ' ' Street Map No..ll~ ....... Block No...~.= ...... Lot No. ~ ..... ~e~ .... ]~.'.e ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~...~.~..., 19.69. pursuant to which Building Permit No~.~ .... dated ......... ~...~ ..... , 19.~, 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 .. P~91t, e .O&~'&ge. (. Aee~lsz'7. ~421d..~ ............................ The certificate is issued to . .eTIBe~ .~ll~l ...... ~.._~er, lessee or tenant) of the aforesaid building. SuffOlk County Department of Health Approvai .I. ,.~.~ ............................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMrr (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4349 Z permissio~ is hereby granted to: · &ee.~mm~ee;s~.-..d~.-Jed~,../dmuLe ...... .................... ~o~;~ZA ........................................ to .... ,...~..~.~,~.R~...~.~..~L.~J~ ................................................. at premises located at .............. ~/~.....,~LG~v~13,..~eG~....~& ............................................................... ............. "",; .................. ~ .......................... i~lel~Le. ........ I.%.. .......... ~ ......................... ....................... ~. pursuant to, application dated ................................ ~'~I~G .......... 3~...., 19.~.., and approved by the Building Inspector. ~:ee $.5-~. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE · SOUTHOLD, N. Y. Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMI'~ Date June 18 19 6..9. .... I NS ! RUCTIONS 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 off premises, relationship to adjoining ~remiees or public streets or areas, and giving a detailed description of layout of property must be drawn off 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 inepection 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 ~Build!ng Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Kegu~ations, tar the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant c~Jrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Leo Kwasneski (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, arch~teot, eng'S~eer, general contractor, electrician, plumber or builder. .................................................. · Can~.a~to~. ...................................................................................................................... Name of owner of premises James Knowls If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which praposed work will be done. Map No.: ......... 7,,T, .......................... Lo$ No.: ..~ ............. Street and I~,--I~. N/.,8 Indian Neck La ?econi¢ ' '-x-"7-z'"'z5 ........................................................................................... , ici lity 2. State existing use and occupur~t o{ premisa~ and intended use and occupuncy o{ pra~:m~t can~'ruction: a. fixistimj u~ and occupan,~t ..... ~I~'~.~.~D.~ ............................................................................................... ..... ~ . c s din b. ntended u,e and occu ,c .., ...... ....... g ......................................... 3. Nature of work (check which applicable): New. Building ......~t..; ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition.....; ............ Other Work (Describe) ........................................ (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 .........oaae...*.....~ ......................... ~., ........... : .......................................................................... 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. .......... 1.6~ ................... Rear ......... .~6 .............. Depth ...... ~.~, ............. Height .................... Number of Stories ......... o~e ...................................................................................................... 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone or use dlstrict in wl~ich premises are situated ...... .a~..~...~.~.t, ............................................................................ 121 Does proposed construction violate any zoning law, ordinance or regulation? ............. .~...O.. .......................................... 13. Nome of Owner of premises ~Ta.s.~..]~13o~l& ............. Address ......... ~.ee4)~.o .................. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..... ~e-o..Kw&sl~eslrt ................ Addcess ......... ~.olzt]:Lo3J~ ............... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram 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 COUNTY OF Leo KWasnesk~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................. ..~.g.~..~?..~g.-~.g~- ............................................................................................................... (Contractor~ agent, corporate officer, etc.) of said owner or owners, and is duly authorized, to perform o?. have performed the said work and to make and file this application; that all statements contained ~n ~his 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 , ................. . ..ddyof ......... .......... ....... . , . _ ............................. Notary Public,~/~41~ ~ _~--~_... L;ount~J',~a {:>~gnature at app.cant~ ~erm Expires M~rcb 30, ].~.7~