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Home My WebLink About5821-zFORM NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate O[ Occupancy No. Z~296 ...... Date ...J..u%y..2.~. ................. ,19.7.3.. THIS CERTIFIES that the building located at . .2.1.~..5..~.a.y...~.v.e.n..u.e ......... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...A~?.~.~...~.q:. .......... , 19.~.~. pursuant to which Building Permit No..~.8.~? .L.. dated ...~p.r.$1...1]. ........... , 19. ?.2., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... X. q.e.e.s.s..o.l~..B..u~..~.d$.ng ........................................... The certificate is issued to ..... .~.~.c..h.a.r.d...~.z..a~.y.k.o. ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... .N: .R.. ......................... UNDERWRITERS CERTIFICATE No ................ .N.o.R.: ........................ HOUSE NUMBER . ~1.3~ ........ Street .P:.0.: .B. 9.x' .~.8...B.a.y...~.v. gn..U.~.~' FO~ 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) 5821 Z Permission is hereby granted to: ~Lel~t..~,a~,,~ ........................................... ..... ~lix"l'8 ............ ~..&,re ............................... .......... Eas.t..l~a~J~l ......... ~.~. ........................ to ...~...~..l~....a.~.e...e.?...s.~....~Al~L~ ............................................................................................... at premises located at .........~..~4J,.~'..~A.~e ........................................................................................ ......................................................... ~a~...);a.~,i~n. ....... tl.r¥.~ ............................................................ pursuant to application dated .................................. ~.1~I1 ........'J,~19...~Ll~, and approved by the Building Inspector. Fee $.~J.g.e.O~ ........... FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~....../....~......, 19.?.....~' Approved ~' ~ ~' ;'~ ~ ~ / ~ ........................................ , 19 ........ Pemit No ..................................... Application No. ,.~....~-:.. DisopproYed O/C .....~-....~......~ .............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Dote ....... .Ap..z: £.]. .............. ;1.4. ....... , 19..7.2 ...... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. 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 of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. I d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant'. Such permit shall be kept od the premises available for inspection throughout the w(~rk~ 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 Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffo[h 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, ordnances, building code, h~ousina cf3der and requlatlons, and to admit authorized inspectors on premises and in buildings for necessary inspections. IL TO :" ~ Rzchard Szaryko I 221 37 9.0th Avenue ~ ................. ~ ...................................................................... (Signature of applicant, or nama, if a corporation) [ Queens Vzllage, New York 1142~ \ ./ ~ . ~ 21357::.. Ba.y...A~ ~...Eas.t..~arioA ~N, Y. ~.~~ . ~ ., ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.. .................................................................. owne.~. .................................................................................................................. Name of owner of premises ........ ]~J,char&..E~za=¥k~ .................................................................................................... If applicant is a corporate, signature of duly authorized officer. ": .................. i .................. :" 1. Location of land on which proposed work will be done. Map No.: ..... 3r.w,x~ ..... Lot No ....... 3rJt.r,~ ............................. Street and Number ...............;2135 ............ ~ay..~.~/~nue ................................. Eas.t..Mario=~..H,Y...; ................ Municipaliw 2. State exi~ing um and o~upancy of premiss and intended u~ and ~cupancy of propo~d construction: a. Exi~ing u~ and occupancy ................ ,~=~..~..~..~e~l~g ................................................... b. In~nded u~ and ~upancy ............... W~..W~h..~D.Q~.~..h~[~g .............................................. 3. Nature of work (check which applicable): New Building ...... ,XZ.~X ....... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) 4. Estimated Cost ...... ~i2.0.1~ ................................ Fee ................................................................................................. (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 ............................................................................................................................................ 6. If business, commemial or mixed occupancy, specify nature and extent of each type of usa ...., ................................ 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 ...... ~0.~. ............... Depth ...]..0h ....... Height ....... :7..~ ...................................... Number of Stories ...... 1 ................................................................................. 9. Size of lot: Front ........6.0..~. ....................... Rear .......... ~0.! ......................... Depth .....L0O.! ..................................... Height ....i ............................................... Number of Stories ...................................................................................... 10. Date of Pumhasa ..... l~ou.....~.~9 ............. Name of Former Owner ..... Sk~apeY,., ....................................................... 11. Zone or usa district in which premisas am situated ...... '.LP,'.'. ........................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... p.~ .............................................. ~;. 13. Will lot be regraded ................ no .......... Will excass fill be rem~ved from premises: [P_a__.q~/W--Lq~,e~ ] Yes [ ] No 14. Name of OWner of premises ..JLi,~Jl,~,K~..J~X.,.a,~';y'.kp. ............. .j~-~"J~'..l, ja~,["l:xa, ............ 4.'/.7..'=1.19~ .......................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ...................... .". ................. .". ............................. .". ........................................ ..". .............................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. ~ STATE OF NEW YORK, ) ~ COUNTY OF ................ .~iz f~o,].k .................. ...................... ~.~,c]P-B.~.~..-q~-a-~.~'.J[o. .......................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individ~d signing contract) He is the ............................................................ .Q. Tt~.~.~.....-.....~g.~.~,g..~.O~ ................................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is d~ly 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 the manner set forth in the application filed therewith. LrLIZABEI'H ANN NEVILLE NOTARY PUBLIC. State of ~lew York 'l,~l'*t da of ' No. .B125850. ,Suffol~ Co ........................... y ..... ~,...~/3r..~ 1 ............................ 19 .....22. .... ~ ,, .,~ixpires March 30. 1~"~ Notary Public, ~.~.~ Coun~~~.~~ .................................. lO0. O % ~P oF ~U12VEyED dOl.-lid LAMD AT MAI2IOM L~\v yo~ E-~U&I:tAIJ~'r~,D TO TU~, TITLr= {.~U,~r~.',UT'.-E CO. &MD *TO TNt-- ~,OUTI4OLD ~,AVII.JF..t,~ B~AM~..