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Home My WebLink About5211-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~,;h,.~ ...... Date ........... NOV...12... , 19.?~i. THIS CERTIFIES that the building located at I~/~ Tttc~eV~ ~ .. Street Map No. ~ .... Block No. ~ ...... Lot No..~ . ~o~thol~ ~,Y, · conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... April ~ 19 ~l p~suant to which Building Permit No. ~l IZ dated ...... A~tl . .~.., 19.71 , was issued, and conforms to all of the req~re- ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued is P~ivato ~ f~ily d~ell~g ............................... The certificate ~ issued to . Anto~ ~kevi~h. .~ner. ................ (owner, lessee or ten~t) of the aforesaid building. Suffolk Cowry Department of Health Approval g~e. 30~. ]071' · by. R., .Vit.!a- Building Inspect~ ~0~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT, (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHO~JZED) N? 5211 Z Permission is hereby granted to: ~ . ............ ~.~J~..~se~....~. J~t~.~e~ at premises located at ............ ~iJJJlr~j~..~jjJ ................................................................................... pursucme to application dated ................................. ~JflJ~;L~.....~t......~., 19...~.$, and app?oved by the Building Inspector. ~ee $....tJJ*lJ~ ........ _ Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JUN~o lg~l Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located 7'?~/i~.~',~ /~2z~- /~'~'c, ~ ~/o ~z,~n' ~{'~',"~2 ~L~7~b., (Gi~'e deed loc~tion) have been inspected by this department and found to be satisfactory. ~aief of 8emeral ~gineering ~ervicee 'IX)~YN OF soUTHOLD----/x/'~'~'~'~' ,~/~ 0,'/.~ BUILDING DEPARTMENT/J ~ TOWH ~LERK'S OFFICE ...... ...... , A~li~tion No ............................. ~r~od ........................................ , 1~ ........ ~rmit ~o ..... ~.... ~/~ Di ' ~ ~ ~/~// -~'~ ~ ..... _ . ............. ~!. '~ ~ ~- (Building Inspector) .A~t~~ ::~ :' ' '~' ~/:'1,~.,,' :~ '1~ ~te ................. : '.~.'" ~ ........ ....... ............ a. This application must be completely fill~ in by t~ewriter or in ink und submitted in ~pli~te ~ the Buildin~ In~ec~r. b. Plot plan showing I~otion of lot a~ of buildings on premises, relationship to adjoining pmmim~ or ~ublic streets or~ or~s, ond givl~a d~ailed deScri~lon of I~out of pm~ must ~ drawn on the di~ram ~Jch I~ ~ of thle ' c. ~e workcover~ by this application may not be commenced before issua~e of Building Permit. d. Upon ~r~al of this application, the Building Ins~ctor will Issue o Buil~i~ Permit to the applicant. ~all ~ kept on the premises ~ailobte for inspection throughout the p~ress of the work. e. No building s~ll be occupied or used in whole or in part for any pu~e whatever until a Cl~iflcate of shall h~e been gmnt~ by the Building Insp~tor, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Low~, On:linonces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition0 '05 herein deecribod. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, end regulations. Jose h Radick (Signature cf applicant, or name, If o corpomtlofl) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................... ~uilde~. ............................................................................................................................. Nome of owner of premises ....A~e...]~Pk~v~ ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which proposed work will be done. Mop No.: ......... 7~ .......................... Lot I~1o.: ....X,~, ............ Street and Number .............. ~_~.k~s...~szte .................... ~.9.1~.t,~9,1,~ .................................. ;'"t ...................... ~ :~'~ -- /~.7-~ Muncpa t~ / State existing use and occupancy of premises and intended use and occupancy of proposed co ,d~tructlon: a. Existing use and occupancy .......... ~a. caZlt..~l, mnl[...L .................................................. r ......... I~ ......................... b. Intended use and occupan:, . ................ ne"f a t '"d el' .2111 .................................. ? .............................. 3. Nature of work (check which applicable): New Building ...~:Z~ .... Addition .................. Alteration .............. Repair .................. Remova} .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............... ~.gOl~..._~o ........................ Fee ....... .1.0~0(~ ...................................................................... (to be paid on filing this application) . .5. If dwelling, number of dwelling units ....$~ ................. Number of dwelling units on each floor ............................ ~ 'If garage, number of cars ....... 112e ............................................................................................................................... 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 .................................... Rear ................... ~ ........ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............. ~...~..~. .......... Rear .......... ~.....~.... Depth .......2B../2~... Height .................... Number of Stories ..~M ............................................................................................................ 9. Size of lot: Front ....... 1.00 .............. Rear ....... .1.0~ ..................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ........... ~,....~&~t~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... l~.~ .............................................. 13. Name of Owner of premises ..... .&~C~A...eT.o~i~eq,~ddress ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Rad~ch Name of Contractor '"~$1' ......................................... Address ............... ~$~h~l']c~ ......... 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 description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF "'$1x~fl~lr ........... J ' ................. ','Z'. .......... y'.'~:~h"~[a~cet',". ........... ~ ................. being duly sworn, deposes and says tmame at ma]vra~a~ s~gmngapprication~ above named. He is the ......................... ~e,.l~e.~ ..................................................... .'~ ................... ~ ..... (Contractor, agent, corporate of said owner or owners, and is duly authorized to perform or have performed the said wore ~and this application; that all statements contained in this application are true to the best of his tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ................. of ......... ....... Notary Publ,~i~ · of E~BETH AN~ NEVILLE NOTARY PUBLIC, State of New York Term Explre~ MBrch 30, he is the applicant etc.) make end file belief; and