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Home My WebLink About4230-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .w..~./~R.bf.)~'14/~t'..}F'P Street ~ap ~o...~'. ~ ....... ~lock ~o. ?..X. ...... ~ot ~o...~.~. ,. conforms subst~tially to the Application for B~ld~g Permit heretofore ffl~ in this office dated .... ~f/..~ ....... , 19.~ ~ p~su~t to which Building Pemit dated ...~ .Z ......... , 19~.~., was issue, ~d confoms to ~1 of the req~re- ments of the applicable provisions of the law. The occup~cy for which ~s ce~icate is ~u~a i~..~e!.e~.. ~ .~em).~.. d~//.~*~ ............................. The ce~ificate is ~su~ ~ ~ ~ ~ P~ (owner, lessee or ten,t) of ~e ~ores~d b~l~g. Suffo~ County Dep~ment of Health ~pprov~ ~. · ~ ~ · ~ ~..~~. ~ Bffild~g ~spee~or FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? /~230 Z ode ......................... .~ ....... ? ........ , ,9..(~. Permission is hereby granted to: ..... J., ..~I~o~$.,..,~,/m, ..~T.,..¢~.Z~.. &, .................... ~t~e~& ........................................ to ............... [tL~L~...n~.~:...O~:a~ .. ~'~m~:L~... ~*~L~L~ ..................................................................... at premises located at .........~J~..-,-~~ ':L~Ve .................................................................. ................................................ ~t,~e~ ......... ~,~.,- ......................................................................... pursuo:n~ to application dated ........................ ~j,~. ...... .? .............. , 19.~;).., and approved by the Building Inspector. Fee $..~J,~,.i~. .......... Building I n~sp~¢foF S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Perm No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a (Give deed location) structure located have been inspected by this department and found to be satisfactory. District Engineer Examined ..... .7-..., 19./~g Application No.. I..~..¥..~...~.. " ', App~v~ .................... ,19 ....Pe~it No ........... Disapprov~a/c ..~ .................. ~ ~ ............... ~PLXCATX~ FOR BU~DIS~ ~RMIT INSTRU(,q'IONS Date ................ ApZil.-7 ........ 19.6~ Building Inspector. b. Piotplan showing iocation of lot and of bnildingson premises, relationship to adjoining premises or public streets or 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 application may n~t be commenced before issuance of Building Permit. d. Upon approval of this application, the Building In spector will issue a Building Permit %o the applicant. Such permit shall be kept on the premises available for inspection throughout the pregress of the work. e. No building shall be occupied or used in whole oV in part f~r any purpose wha~ev~ until a Certificate of Occupancy shall have been granted by the Building Inspeelme. APPLICATION IS I-~_~l~y 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 applinable Laws, Ordinances or Regulations, for the construction of bnildings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to com ply with all applicable laws, ordinances, budding code, (Signature of .applicant, o~ name if a corporation) This application must be completely filled in by typewriter or in ink and submitted in duplicate to the _~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~.%l~[J.(~. .............. Name of owner of premises .... ~r.0~'Ph..~. ~.QphJ. e..C],~rd.%ll~O ......................................... If applicant is a corporate, signature of duly authorize d officer. (Name 'and title of corporate officer) 1. Location of land on which proposed work wi]] b e done. M.ap No ........... ;;~ .... Lot No. XX ........... r( ! - ~ 9t D Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy . .yacall~. ].&lid .................................................... b. Intended use .and occupancy ..... olle. J~ar.t ~ y. d.weLllng ...................... ; .............. 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost .... 16.~QQQ .~ ................ Fee ...10. ........................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...O~f~.... Number of dwelling units on each floor .............. - If g~rege. ,number of cars .... OZte ....................................... .; · ·., ..... :~. ............. 6."~'if L~t~'gs~ commercial or mixed occupancy, spec ify nature end ex~t of each~'pe 06~ .......... 7.Dimensions of existing structures, if a~: ~,~/~n~_.~ ............ Rear ,. ........ ;... Depth .......... Height ................ Number of Stories ........................................................ Dimensions of same structure with alt~r/[~d~ ~ ~tion~.~l~'~n-~-.;; ~.; ;=T;....-z-l%'ffar ............... Depth ................ Height ................ Number of S/~ries ..................... 8. Dimensions of entire new construction: Front ..... ~. ........ Rear ...60. ........ Depth .28 ........ Height ............ Number of Stories.. ~. ~,~ ~xx,~.. '~'~'~'.~..~i ..................... - - 9. Size of lot. Front ...~.00 ........ Rear .~0~. ~..~,...~ i Depth . .225/. ~T0.. · 10. Date of Purchase ....! 9.6.9 ...................... I~ame of Former Owner ...J. ~..~eb~:oski ........... 11. Zone ar use district in which premises are situated...."A}~./;l;l.S.t ...................................... 12. Does proposed construction violate any z~ning law, ordinance or regulation? ........................... 13. Name of Owner of.premises ;[oaeph .. CJ.&l~UlJ2~ddress · · .Southnld ......... Phone No ....... ; Name of Architect ............................. A~ldres~ ...................... Phime No ............ Name of Contractor .. Julius .Zabrosk£ .... Address ..... ~%o%l.tho~lA ...... Phone No ............ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give,street and block number or description acoording to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, )S.S. COUNTY OF .~.fOl,k .... ) ............... i" ~.~l.~:%t~ · .~e~3[,os]~. · ..... ,. ....... being duly sworn, deposes and says that he is the appli- (Name o~ individual s~gmng application; cant above named. He is the ..... QO~t~;~'&~C0X .......................................................... (Oontraetor, a~ent, corporate officer, etc.) of said owner or owners, end is duly authorized to per, tm or have performed the said work and to make and file this application; that all statemerds contained in this application are true to the be~t of his knowledge and belief; and that the w~k will be perfuemed in the mann er set forth/in the application filed therewith. Sworn to before me this .............. 7. day of ........ .il%l;'~;],.;;; 19~ .~9 ' ' ELIZABETH ANN N~VILLE' NOTARY PUBLIC. State of New ,o. 52-8125850. S~ffotk C0~/ ]'~rm ~xpires March 30.