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Home My WebLink About4191-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2, .3~.95 .... Date .......... ~ay. .... .27, ...... , 19.6.9. THIS CERTIFIES that the building located at .Nakomts. Road ........... Street Map No ............. Block No ........... Lot No...$ottthol~lo..New..York ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ... February .... 24,.., 1{]69.. pursuant to which Building Permit No..4191. ?-. dated ... February .... 24,..., 19.6.t, 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 ... Accesaory. bull~ltng..(pr;tval~e, gar. age) ........................... The certificate is issued to ..... Michael. Kalsch .................................. (owner, lessee or tenant) of the aforesaid budding. Suffolk County Department of Health Approval .................................... Building Inspector ~ House % 850 Nakomis Road FORtVl NO. 2 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? 191 Z Permission is hereby granted to: ................. ~o~tl~Z~ ........................................... to uS~..~~ .~e.t,e~,h~.cL ~.c.e~ ~ut:.dt .......................... W/.~...~alcom~.s..~o~/t ........................... . ..... of premises located at ~ ~ ................ -~1 eu¢t~o.~1 ......... ~,.~., ..................................................................... pursuan¢ to application dated ........................ ..~..e...~. ......... ~ ........... , 19....6..~.., and approved by the Building Inspector. Fee $. ~.e.Q.0, ............. ,NO. 1 Examined ............. t: ....., 19 ...~.. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~:RK'S OFFICE SOUTHOLD, N. ¥. Application No ................. Approved .................... ,19 .... Permit No .................... Disapproved a/c (Bull,ding Inspector) APPLICATIOiN FOR BUILDING P~RMIT D~te .......... ~/,~, ~ ........... 19~.,2... INSTRUCTIONS a. This applieati~on must be completely filled in by typewriter or in ink and ~su~mitted in duplicate to the Building InspecOOV. b. Pk)t ~lan showing l~cation of ~t and ~f buildings o n premises, relationship to adjoining premises or public streets ~ov areas, and g!ving 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 application may not .be commenced before issu.ance of Building Permit. d. Upon approval ,of this applicati,~n, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept ~n the premises available for inspectiC~ thruugh~t the progress .of the work. e. N,o building shall be occupied or used in whole o~ in part 5yr any purpose w.hatever until a Certificate Occupancy shall have been granted by the Building Inspector. APPLICATION IS ~Y MADE to the B~ilding Ddpartment for the issuance of a Building Permit pursuant to the Building Zone Ordinance o£ 'the Town of Sa, uthold~ Suffolk C~unty, New Y~rk, and other applicable Law,s, Ordinances ,or Regulations, for the construction .~f build ilxgs, additions ov alterations, ~r for removal or demo- lition, as herein described. The applicant agrees t9 comply with all applicable laws, ,ordinances, building code, hoxming code, a~d regulations. ....... 5. ....... (Signature ~f .apphcant, m: name if a corporation) (Address of appl~dant) State whether applican, t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ov builder .....-'~...Z_~.../..~..~...~..,'~. ............................................................................... Name of ,owner of premises ./~./ff..~.~. ~./~. · ·/~.~..~. ~..~. (~/ .............................................. If applicant is a e~rpqrate, signature of duly authorized o/ricer. ... (Name and title of corporate officer) 1. Location ,of land o,n which proposed w~ork will b e done. Map No ................. Lot No .............. Street and Number .~.~f'~.o.~7./'.~. Y~4~. · · · ................... 2. State existing use and ,uccupancy of premises and intended use and ,occupancy of proposed construction. a. Existing use and occupancy . ,/,...,~.2Z..~2..]. --~.~. -...~. ?~.~. ,L, .K/M ~ ............................... b. Intended u,se ,an~d ~occupancy ................................................................... 3. Nature of work (check which applicable): New Building ........ Additi~on ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Othe.r Work (Describe).~.~..o('....{.~..~...~..~.~.~ 4. Estimated C,3.st ./~..o..o ......................... Fee ................................................. (to be paid ,~n filing this applicafion) 5. If ,dwelling, number ,of dwelling units .......... Number of dwelling units on each flo.or .............. [f ga.rage, number ,cf cars .../ ...................................................................... 6. [f business, comme,rcial ,~r n~ixed occupancy, spec/fy nature and extent of each type of use .............. 7. Dimensi,ons of existing structures, if any: Frvnt . .~.~.~ ........ Rear . ~. ~..r. ...... Depth .~. ?..' ........ Height . ./.~..' .......... Number of Stories .. {. .................................................... Dimensions ,of same structure with alterations .or additions: Front .............. Rear ............... Depth ................ Height ................ Numbm' of S6o~ies ..................... 8. Dimensions ,of entire new construction: Fro'nt ................. Rear .............. Depth ............ Height ............ Number ~f SSo.ries ............................................................. 9. Size of ~ot: Front ./)...~. ......... ~ Rear .../.~.. ....... Depth 23~ ~ 10. ;Date of Purchase ..... ./.~...~./ ................. Name err Former Owner .~...~....~(.../.~.~../~..~. ~ ........ 11. Zone ,or use district in which premises are situated.. Y~..~../.~...~'~{...~.~...~-r.. ............................. 12. Does proposed construction violaie any z,~ning law, ,ordinance or regulatiern? ........................... 13. Name ,of Owner.of premises/~. (.~..H.~?/-.. ~/q .i.~'.C/~Address S'~ ~ -~/4'~ ~ ~> ~'kd' Ph,~ne No. Name of Architect .............................. A~ddress ...................... Ph~r~ne No ............ Name ,of Contrac~or~..~.'~.~...~..~/.q.~..~./.x..~..~..~.. Address ¢~r~.~.'.~.~..~..z. . .~.)..~./ Ph,mae No..~.~...~.4/ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frOmindicatePr~o.pertYwhe~cherlineS.interiorGive street, or cornerand 1,ot.bl°ck number ,vt de scripti, on according to deed, land ih,ow street names and STATE, OF N.EW YORK, )S.S. COUNTY OF .............. ). ....~.'.~..e~..//~.../-.--./..~..~..~..)~r.~..~..~. .................... being duly sworn, ,deposes al~d says that he is the appli- (Name ,of individu.al signing applicati, on) cant above named. He is the ....~.t2..4 .~...~...~-~- ........................................................ (Gontractor, age,nt, oov]porate .officer, etc.) of said owner ~or owners, and is duly auth.orized to perf,~rm or have performed .the s.aid w~rk and to. make and file this application; that all statements oontained in this application are true to the best of his kn,owledge and belief; and that the wJ~rk will be perf~,rmed in the mann er set forth! in the application filed therewith. Sworn to before me this N~ary Public ............... ~ .... Gounty (Signture of applicant) MARION A. REGENT NOTARY PUBLIC, Sta~e of Now York ~o. 52 3233120 Suffolk Counl~