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Home My WebLink About5576-zIrOBM NO. 4 TOWN OF SOUTHOLD BUff.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Lighthouse. t~d ...........Street Map No..xx ......... Block No .... xx ..... Lot No... x~.x... ~ou~;hold...I'; .~.. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Oct ..... 2(1 19.7.1. pursuant to which Building Permit No. ~.~6~.. dated ............ Oct .... 20.., 19.71., 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 ...,~.cevsa~y. b~!ldir, g. [..(.ato~'~g~ .,~t.c.). ............................ The certificate is issued to . .Claudett~ · .De.~pl~nch~$ .......... t.~-n~ r. .... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......E.:H.: .......................... House ~ 2560 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 5576 Z Permission is hereby granted to: ...... at premises located at .........'l~flJl"~J"~/4j~jj"~ .................................................................. pursuon~ to application doted ............................. .~1~ ......... ~t ......... , 19.~[I~.., and approved by the Building Inspector. Fee $.~e~lO ............. Building Inspector' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........~....~ ......... 19..?./. Approved ....................... ..~.. ............. , 19..J).... Pemit No.....-~.....~..~..~.......~.... ........ Application No....,,,~,,~....7....~. ............... Disapproved o/c ............................................................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Oct 20 71 ~ Dote ................................................ , 19 ............ a. This application must be completely filled in by typewriter or in ink end submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relot[on~ing premises or public streets or areas, and giving o detailed description of layout ofproperty must be drown~ which is part of this application. c. The work covered by thL~ application may not be commenced before 1~l~lding Permit. d. Upon approval of this application, the Building Inspector will issue o B~~it te the applicant. Such permit shall be kept on the premises available for inspect.~ throughout the. T~rogress of the work. e. No building shall be occupied or used in whole or in part for a~Y purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/v~ADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees 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) · 2. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor If applicant is a corporate, signature of duly authorized officer. ,~ .................. ......... ?/ ]. Location of land on which proposed work will be done. Ntap No.: ........... ~ ...................... Lot No ........ ~ ..........~ Street and Number ........ ~./R..../.J~l~th=use..l%oa~%....~e~g~e.l& ................................................................... 7:~ ~ ~'~)' -~' ~ ~) Municipality State existing, use and occupancy of premises end intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~..w..e.,~.~..~ .......................................................................................................... b. Intended use and occupancy .......... ,s..~..~...e....w..~?,...~...§..c..c.,e...s..s...o.~...~b.~.~,~.~ .................................................. 3. Nature of work (check which applicable): New Building .... ~ ........ Addition .................. Alteration .................. Repair .................. Removal ........... : ...... Demolition... ............... Other Work (Describe) ........................................ 4. Estimated Cost ..~-... .......................................... Fee ~,,00 (to be paid on.filing this application) none 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ....... ; ........................................................................................................................ 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 ac additions: Front .................................... Rear "7' ....................... E~epth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............... .1.(~ ................ Rear ......... ].0. .............. Depth ...... 1.~) ............. Height .................... Number of Stories one Size of lot: Front ........ .1.(32 ............. Rear .................................... Depth ....... .br.0~.r ................ Date Of Purchase ........................................................ Name of Former Owner 1 i. ZOne or use district in which premises.are situated ........ ~.'~.?...dis.t ........................................................ : ............... 12.' Does p~opoSed construction violate any zoning law, ordinance or regulation.;> ....... 3~ .......................................... ..v.%. 13. Name of Owner of premises ..C-~..~es.p~e~....Addres~ ............................................ Phone No Name of Architect Addres~ ............................................ Phone No. Name of Contractor ..L,..Ewe. s~,es]~1 .....................Address ........... ~.g.~l,~Q~(~ ............. Phone No. Locate clearly and property lines. Give Street:'¢ whether interior or corner lot. PLOT DIAGRAM existing or proposqd, 'ar~ indicate all set-back dimensions from description according to deed, and show street names and indicate STATE OF NEW YORK. ' tS S Cg.U. NTY OF ...... ~..]~.~g,,~, ........ ~ ' .~::uu~u:.~%..~?.~..-~.y~-~. o-;,~,w~8~e~]~-~. ............................ [~.being duly sworn, deposes and says that he is the applicant jr~ame at inaiviaua~ ~igning application) above named. He is the ...................... .C~o33;L~'.~.~.f;o~'. .......................................................................................................... .~ (Contractor, agent, corporate officer, etc.) of..said owner o? owners, and is'duly~.authorized to perform or have performed~ ~he said work and to make and file thru apphcahon; ~that~ll statements ~gntomed n th s application are true to the best of his knowledge and belief; and tha~.:.t~,..wotEwilh~ i~erfO~med in the r~anner set forth in the application filed therewith. Swam to before me this .................... ,_ __,,, ' ...... · ............ : ..................................... Notary NOTARY ?UBtIC. b~a e , ,,. .... No. 52-8t25850, S~flol~ Te~m [xpires March 30,