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Home My WebLink About4259-zFO~ NO. 4 TOWN OF $OUTHOLD BUH,BING DEPARTMENT Town Clerk's Otiiee $outhold, N. Y. Certificate Of Occupancy No. · .353.8 .... Date ......JUly ......lie ......., 196.9. THIS CERTIFIES that the building located at Joekay.¢z~ek. l)zlv~ ...... Street Map No ............. Block No ...........Lot No.. ~out. hold,. ~[$~..York ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....APl:Il .~l, ....... , 19.69. pursuant to which Building Permit No..4259. A. dated .....A. plc.i.~ .2.1, ........ , 19.6~., 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 ..... J~¢~m~lol:.y..bu;Ll,d~g. ............................................ The certificate is issued to . .Y~.ci:or. CJ. ezack ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Eo~e ~ 12eO ~oc~e~ Cze~k DzJ.ve 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) 4259 Z Permission is hereby granted to: ................ ?.~.~L~ ........... d.'..~..~.~? 19..~..~./., and approved by the pursuan¢ to application dated ............................................................ , Building Inspector. Fee $....~......~... Building Inspector ¥7/;4 IF'ORM ,NO. I TOWN OF SOUTHOLD BUILDING I)~PA~T TOWN CI,~Rlr'S OFFICE SOUTHOLD. N,. Y. Disapproved a/c .................................................... Application r~0 ......... f... · ' APPLICATIO~N FOR B'UILDING P~RMIT Date ................ .~. · .~.....~.~?. !..L~. 19. · ,~ INSTRUCrtONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building InsPec/~yr. b. Plot 91an showing location of lot and of buildings o n premises, relation~ip 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 r~t 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 inspection throughout the proKress of the work. e. No building shall be occupied or used in whole o~ in part for any purpose whatever until a Certificate .of Occupancy shall have been granted by the Building Inspee~oL APPLICATION IS 1-1~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, 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 herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. ~ ~ (Signature of .af~plicant, or name if a corporation) X\ .............. ................ State whether applicant ~/ owner, lessee, ageht, archit ect~ engineer, general contractor, electrician, plumber or builder ................... .~. ....." .L:?..1..~ ................................................... Name of owner of premises .? ..... .~. !..~.."~..O..~. ....... .~. !. ~ .~...~...~...~. .....i ......... i..ii ......... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which propesed work will b e done. Map No ................. Lot No .............. Strut and Numar ................................................................................ ~/L ~ ~ ~ ~ Municip~ity 2. S~te exist~g u~ and ~p~ ~ premiss ~d intend~ ~e ~ oc~p~ of p~ ~ction. a. ~isting use ~d ~cup~cy ...... [ ~ ~/Zy ~IDEN~- b. Int~ded ~ .~d ~p~cy ..... ~.~. ~l~ A ~ ~ ~U/~/N~ 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost .............. /.U ............... Fee ....... ~ ................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... Number of dwelling unit~ on each floor .............. If garage, number of cars .......................................................................... 6. If business, commercial or mixed occupancy, spec ify nature and extent of each type of use .............. 7. Dimens/ons 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 ..... /..~. ........ Rear ..... ./..~. .....Depth ............ Height .... ~. ...... Number of Stories ............................................................. 9. Size of lot: Front ...... /..~...O ....Rear ..... ./..~....O.... Depth ..... .~.. ....... 10. Date of Purchase ............. ./.~.~..7.... Name of F ,o~n, .er,,Owner ........... . .7~..~.-..)~.7~ ...... · · .~ ~, re ~.s ~ ~ ~v ~/~;)' ........ 11. Zone or use district in which prem~scs are mtuated ................................................. 12. Does proposed con,ruction violate any zoning law, ordinance or regulat/on? ...~ ...................... 13. ~,,,,=,, .... '=~'~' "'=""°=° ............................ D~"l*~'a' ...... ~-none mo ........... Name of Architect ............................. /~ddress .... $.~..V.T.~.o' .~.o.~ ..... Phone No ............ Name of Contractor ............................ Address ...................... Phone No ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prop0sed~ and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~t~'~,. 1.5o STATE OF NEW YORK, )S.S. COUNTY OF .............. ) .................. ~ ..... ~ ./..~.-.~...~..C...~. ......... being duly sworn, deposes and saya that he is the appli- (Name of individual signing application) cant .above named. He is the ~./..~ (Oontractor, agent, oJrporate officer, etc.) of said owner or owners, and is duly authorized 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 work will be performed in th~ mann er set fortif in the application filed therewith. Sworn to bef<rce me this ~ u ~?~c..~,.,~ .................... N~tary Public, ................................ (~lgntllxw-of applicant) ~1o. §2-812§850, Suffolk Count'/