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Home My WebLink About4189-zFORM NO. 4 TOWN OF SOUTtIOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No... ~.. 34.7.9.. Date ........... t~a¥ ......... 9,..., 19.69. THIS CERTIFIES that the building located at . 14icld.~e .Ro~tcl ............ Street Map No ............. Block No ........... Lot No.. S~t~lao.l.d,. }~,~. X~oa:l~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... l~'aD~ctla~Ir.. 2~S,., 19..69 pursuant to which Building Permit No.. dated ..... F~DlCu~Ir.. 2.4e.., 19..69, was issued, and conforms to all of the require- ments of the applicable provisions o~ the law. The occupancy for which this certificate is issued is .... Btl~.in~ss..l~uilding ............................................... The certificate is issued to .. 8.teve..J.. D.o:coSki .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... }louse # 1~3- 38895 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~189 Z Permission is hereby granted to: .......... .s.~.$.~gA.a. .................................................. at premises located at ............ ~...~[~..~,..~i[..~..~/~..~]~G~'.~.~r..-DOt~J.--~e...~O~ .................................... J[o~ttu~d....~.~. .......................................................................................... pursuan¢ to application dated ............................... ~.,e~ ....... ~ ......... , 19...~, and approved by the Building inspector, Fee $....~,~(~ ........... TOWN OF SOUTHOLD /¥/.., ~WN C~:RK'S OFFICE ~ SOUTHOLD, N.Y. ~ ~'q ~ Approved .................... , :[9 ....Permit No .................... Application No./-1 ( ~ ~ APPLICATIO,N FOB BUILDING PERMIT Date ................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec~(~r. b. Plot 1~lan showing l~cation of l~t and of buildings o n premises, relati~nship bo adjoining premises or public streets ~oT 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 app]icatf,~n may ~ot be commenced before issuance of Building Permit. d. Upe~ approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept t~n the premises available for inspection throughovt the progress of the w, ork. e. No building shall be occupied or used in whole or in part f,~r any purpose whatever until a Certificate ~f Occupancy shall have been gran.ted by the Building Inspeci~or. APPLICATION IS HER~3Y MADE to the Building Department for the issuance of a Building Permit pursuant ~o the Building Zone Ordinance of the Town of S~uthold, Suffolk Oounty, New ~erk, and other applicable Law~s, Ordinances .or Regulati,ons, for the construction .af build ings, additions or alterations, ~r f, or removal or demo- ]ition, as herein described. The applicant agrees tx) corn ply with all applicable laws, ordinances, building code, h.~using code, an, d regulations. 7-¥ .... . . .. ............... (Signature o~ .applicant, or, name if a corporation) State whether applicant is owner, lessee,]~gent, archite~t, engineer, general contract~c, electrician, plumber or builder...b/~.~./..~.~,~...e~.<~., ............................................................................... Name .of ,owner of premises ~.y~'~,~ ~ .~. o.~ ~ ~ ~ ................................ If applicant is a oorp.erate,, signature of duly auth~)rized ~fficer. (Name and title of corporate officer) L Location ,of land o.n which prop,oEcd work will b e done. Map No ................. Lot No .............. Street and Number .. ~...~.~.~. ?..~-... ,~.~..~'- .~. ~ .~ -- ;.~ f~y-~ _.~ Mummp~l{t'~ 2. .State existing use and ,occupancy ,o{ premises and intended use and ,occupancy of proposed construction. a. Existing use and occupancy . .~'..~.~. ,/~ff.q.~.q..~...~.. ~..~..~..~.~./..~.'..a~.,~..¥.~.--t~'.. ~..~.~/.~. ?.?.~. ..... / b. Intended ese .and ~)ccupancy ................................................................... 3. Nature of work (check which applicable): New Building ........ Addition . ..,/.... Alteration ........ Repair ......... Removal ........ Demoliti. on ........ Other Work (Describe) ...................... 4. 2Fstimated Cost . ./...~'~..~ ....................... Fee ................................................. (to be paid ,on filing this application) 5. If dwelling, number ~of dwelling units .......... Number ,of dwelling units on each rio.or .............. If garage, number .of cars .......................................................................... 6. If busine.ss, commercial ,or mixed occupancy, specify nature and extent of each type of use~.~'.~.~.~..~'.~?.~P~ 7. Dimensions of existing structures, if any: Front . ~..-~...~ ...... Rear .../..~.~..~ ..... Depth .:~P. · .~ ......... I{eight .... ~... Number of Stories . /. .................... Dimension.s ,of same structure with alterati,ons .or additions: Front ....--~'.'~..~...~... Rear ............... Depth ................ Height ................ Number of S~o~ies ..................... 8. Dimensions of entire new construction: Fr3nt ................. Rear .............. Depth ............ Height ............ Number ,of Stories ............................................................. 9. Size of 1,or: Front ................ Rear ............... Depth ............... 10. Date of Purchase ............................... Name ~ Former Owner ................. ' ............ 11. Zone .or use district in which premises are situated .................................................... 12. Does proposed coastruction violate any z,3ning law, ordinanee or regulati~n? ........................... 33. Name ,of Ownerof premises .~.Y??..~. .~.¢.~..~ .x..~./... A~ddress ...~'.~..~..~. ~'~. g. ~.2) .... Ph,~ne No ............ Name of Architect ........................... ~,. Address ...................... Ph,~ne No ............ Name of Contractor~.,~/V.~.~,.~. · .-/Z.x.e.°.~..e.~..~?..~/.~'. Address ·..~'?. ?. ~..~. ?..~..'.~. .... Phcme No.~¥.~.~..~.?.3./. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or 'proposed, and indicate all set-back dimensions from pcoperty lines. Give street and bl.ock numbe.r ,~r descripti,on according to deed, and show street names and indicate wheiher interior ,or comer 1,or. STATE, OF NEW YORK, )S.S. COUNTY OF ............ ,.. ) ....~.-~...~./~4/....~.c.~. ~'.~ .~.Y..~7.'M.. ................... being duly sworn eposes and says that he i§. the appli- (Name of in.dividual signing application) cant above named. He is the ............................................................................ (Oontraetor, agent, ccrrpo~ate .officer, etc.) of said owner ,or ,owners, and i.s duly authorized to perii~rm or have performed the said work and to make and file this application; that all statements contained in this application ~re true to the best of his knowledge and belief; .and that the w~ork will be perf,ormad in the mann er set forth! in the applicatio~ filed therewith. Sworn ~o before me this ..... .....day,o . N~tary Public, . ................... Oounty (Signture of applicant)