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Home My WebLink About5626-zFORM NO $ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~..~./.~7. Date ] c/ xJ~'h/£ , 19'7.B THIS CERTIFIES that the building located at ~/.5 5 ~ gM ~ ~ P~ k ~ Street MapNo .... ~. BlockNo.. ~ LotNo.. ]~ confo~s substantially to the Application for Building Permit heretofore filed in this office dated .... ~ ~. ~ ~ 19 ~/pursuant to which Building Permit No. ~ ~ ~ dated ....... ( ~ . ~'~P~, 19 ~.1., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which th~s certificate is issued~ . . .~ .... ~.~- ..... F.O.k!~PY... ~.%'.~.~.~.[~).~ ....... The certificate is issued to ~.. ~ .~.~ ~'~ ~ ~ ~ ~- .... ~.~. ~ ~ ~?. ~ ~ .t . (owner, lessee or tenant) of the aforesMd building. HOUSE NUMBER..~.5-~. Street I~OKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5626 Z Permission is hereby granted ~o: .......... ~t...~e~.~tJg..ig~...eJeem~ & w~e crt premises located at ......... ~t~JlL...J~L...~IL.~iiJlII ........................................................ ............................................... ~..~ ...... ~~.. ........................................................... pursuc~t to application dated ............................. ~.....~.~J.., 19.~JJ..., and approved by the BL;ilding l;nsPector. , ............ ' "' ' ' ..... ' ~ · Buildin;~' Inspector ................... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JUN 1 ~ 1973 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~- -~c~ve deed l~c~tion) -,' have been inspected by this department and found to be satisfactory. dUN i 3 1973 Chief of General Engineering Servzces TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT~ ~ . ~ ~ ~ TOWN CLERK'S OFFIGE~ ~ ~ ~~- ~ : SOUTHOLD, N. Y. ~ ' ~ ~ ~ ~ / ~ ...................................... ..... .. , ....... APPLICATION FOR BUILDING PERMIT Nov. 12 71 Date ................................................ , 19 ............ INSTRUCTIONS b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not 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 progress of thework. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. APPLICATION IS HEREBY MADE 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, os herein described. The applicant agrees to comply with all applicable laws, ordi nonces, building code, housing code, and regulations. Julius Zebroski (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises ..~[~:y...&..Ch&rlo~te...Gadomslr4. ................................................................................ ~. If applicant is a corporate, signature of duly authorized officer. .,~ ~L~ .................. ......... '¢ a o Bayside Terrace Lot I_R .~ ]. Location of land on which proposed workwil/be done. M pN .: ........................................ No ........................ Street and Number ..................... $1]rnrn~.~.~..~..A-3,al'~ ............................................................................................................... L/.~ .~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............. .~znca~l;...].~.Z~$, ........................................................................................ one famil dwelli.n.E b. Intended use and occupancy ....... '~. .................................................................................... 3. Nature of work (check which applicable): New Building ..... ~ ....... : Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work. (Describe) ........................................ 4. Estimated Cost .................~'~'~)(~O-'"~' .................... Fee .....1...O..q.Q..O. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ D;D.e ............. Number of dwelling units on each floor ..... , ...................... -- - ' ~.lf garage, number of cars ........... O~.e ........................................................................................................................... 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 or additions: Front ........ L.-, ......................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ,5'J~ ..................... Rear ........... ~ ............ Depth ..... ~ .............. Height .................... Number of Stories -..~.~--z?e..Tteh ............................................................................................... 9. Size of lot: Front ...~00 .................. Rear ....1.(~) ......................... Depth .....1~C~ .................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .....!~.A,~.I...~,~.~ ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ......... .D,D. ............................................. 13. Name of Owner of premises ..~.s...~..~..~D~:L....; ...... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~T~..~.b~.oa~r;L ........................ Address ......~..O..~....t;..1?...o.~,.~.. .................. Phone No ..................... PLOT DIAGRAM 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 descriptio~ according to deed, and show street names and indicate whether interior or corner lot. c~t~,~ ~ (~z,~f STATE OF NEW YORK, t S S COUNTY OF ..~qu,~f.ol]g, ............ J' · ................. ;.: ........... ; ........... ,T.~l..]..~.~l.&..~e~:~o~.. ................. being duly sworn, deposes and says that he is the applicant [r~ame aT individual signing application) above named. He is the ..................... ~.!~::L].~.e~ ................................................................................................................... (Contractor, agent, corporate 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .................. ........ , £LIZARETH ANN f~i~ILLE NOTARY PUBLrC, State of New York No. §2-~125850, Suffolk Cough/ ~rs~rm Expires M~¢h 30,