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Home My WebLink About5404-zFOBM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy No ..... i. ~k~7. Date ..... ~... 2~,, ..... , 19.71 THIS CERTIFIES that the building located at S/~ .~md. ~'~l.~. L~ .... Street Map No. ~ ........ Block No. ~ ...... Lot No. ~..~~,. ~. ~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...0~1¥... 15, ....... , 19.7~. pursuant to which Building Permit No. ~404. I dated ...J~y .... ~,5, ........ , 19.7~., 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 .... pr~.v&~,~ .ona .£am~y. d~,l~V ................................... The certificate is issued to . ~tclml. l~mc~.a ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... .................. .f..( .... Building Inspector 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 AUTHORIZED) N? 5t0~ Z Permission is hereby granted to: ............... at premises located at .........~..~,~AI~..~IdlI~..]~AII4I .................................................................. pursuant to application doted ............................. ~.....~1.~. ........... , 19.~..., and approved by the Building Inspector. ~ee ,.~......m.. ............. Building Inspector TOWN OF SOUTHOLD IUILDINO DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Yo xamined / ........................................ ........ Pe,m,t Disapproved a/c ...... ~...- ............................. ' .... (Building ~ector) APPLICATION FOR BUILDING PER. Mr[ Application No......'~.....~..~....~.....~. .... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the 8uilding~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relatlonsh p to adjoining premlees or public streets or~, areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is part of thl~ appIIcation.~,{ c. The work covered by this application may not be commenced before issuance of Building Permit. d. shall beU~tpppr°val of this application, the Building Inspector will issue a Building Perm t to the applicant. Such permit~, on the premises available for inspection tl~.roughout the progress of the work. 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. ~ APPLICATION IS HEREBY MADE to the Build ng Department for the issuance of a Building Permit pursuant to the RBUildlr~.. Zone. Ordinance. of the To, .wn .o.f..Southold, Suffolk County, New York, and other applicable L.awl, Ordinances or egu arians, tar the construction at Du,amgs, additions or a !erat OhS, or for removal or demolition, al bereln described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. Joseph gia~. (Signature cf applicant, or name, If o corporation) .............. Gr. een~ .............................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises Michel Koscis If applicant is a corporate, signature of duly authDrized officer. (Name and title.of corporate officer) ~'/0 - ~ 1. Location of land on which proposed work will be done. Map No.; ....... ~ ........................... Lot N~ ............ ..~. Street and N]u,~b-, S/S Island View Lane Arsha~omaque, Green orr .................................. ' ............ ,.n,c,pa,,ty ...................... 2. State existing use a.nd occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy dwelling b, Intended use and occu~:an:., .s.,..a~...e...w...i..~..h. ~ .a..d. di,.t, ion 3. Nature of work (check which applicable): New Building ~ ................. Addition ....... ~ ......Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost ............~..~/3.....~ .................................. Fee ...~.~...0~... .......................................................................... (to be paid on fi!lng this application) 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 or additions: Front .................................... Rear ........................... Depth ................................ Height ............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... .~.1; ...................... Rear ....... .~:~.~. ............. Depth ....~7..-..br. ............ Height .................... Number of Stories . e]3e ............................................................................................ 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ....................................................... 1 I. Zone or use district in which premises are situated ........ .A.....I~.~ ........................................................................... 12. Does proposed construction violGte any zoning law, ordinance or regulation.;) ............................................................ 13. Name of Owner of premises .~Lcl~ae'l..T~(3,S.~:LS.....Address .......... G.3::eP-.Z:L~OZ'.~G ............ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..,....D..~.~..~. .................................. Address ...~..~.e~.C~37.~G ................... 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 Jot. .... ~ ~ STATE OF NEW YORK, tee COUNTY OF ...$~tff. e~Lk ............ %~'~' ........................................... -T~.,DcLa~ .................................. being duly sworn, deposes and says that he is the applicant (Name of individual 'signing application) above named. He is the ..................... .C.~3:).~z'~c.t,o;['. ..................................... '. ........... .~ ........................................................ (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 thar the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .............. ..... day of ........................ ....... .... C? Notor/ Public,~'~"~'""~'~'"uuol~'~r ,. SOI(EN Cou~t~ ~" / ~Signat~;e of ap~j~ ............................ Notary Public, Stale of New Yor~ No. 52-0344963 Suffolk County Commission Expires March 30,