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Home My WebLink About5686-zFOEM NO. ~ TOWN OF SOUTHOLI BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.b".~.].( ........ Date J'&l~ ~{ , 19..,.. THIS CERTIFIES that the building located at . .~.l~.~l.e.~ .~.~.a~e ............ S~reet Map No..%~ ......... Block No .... :z~ .....Lot No... ~ .... I~el.. ~, ......... conforms substantially to the Application for Building permit heretofore filed in this office dated .......... D.~g. · ~.Q..., 19 ?.~. pursuant to which Building Permit No...~.~.~.. dated ............. Jar~ ~.., ~ ~ ... 19. ?~., was issued, and conforms to all of the require- ments of the applicable provisions of the l~aw. The occupancy for which this certificate is issued is .P.~'l.V~t .e..o~..~.a. r4.!ly..d.~..~.lIVg ......... ~ ............................. The certificate is issued to . 'Johl~' 'K~;~'wski .... ~)~e~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~;:~R., .......................... FO~ NO. 2 TOWN OF SOUTHOLD i BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT CT'HIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5686 Z Permission is hereby granted to: at premises located at ..... ~.Jj~4JtJ~--J~e-.~ .............................. ......................................................... ................................................... ~te.~..*.tl.,'~ ~ ................................................................................ pursuont to eppli¢otion daled ........................... ~ .............. ~.-., 19..~i., and approved by the Building Inspector. Fee $...~.i~i ......... · Building Inspector TOWN OF SOUTHOLD /~ ' BUILDING DEPARTMENT ~ ~~ ~ ~ ~7~ ~~ :.. Approvod .................................................................................... Disapproved o/c ....... . ........................................................ ................................................ ........................ (8u~ APPLICATION FOR BUIL~ING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 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 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 Lows, 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 oil applicable laws, ordinances, building cede, housinj3 code, and regulations. ..... ...... ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ .0. ............................................................ ., If applicant is a corpo a , s'g y ' ' · '~ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .............. ~ ...................... Lot No. 1~, Street and Number ..................... ~.I~.~.I~.~....~J~E. ............................................... ~.~4~,r~,.. ............................. ~/~/' .~'- ~_~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. .~.~i ............................................................................................... b. Intended use andoccupancy .............. ~,,~/!~'~ ................................................................................................. 3. Nature of work (Check which applicable): New Building .................. Addition ....~ .........Alteration .................. Repair .................. R~emoval .................. Demo t or ....... Other Work (Describe) ............................. 4. Estimated Cost .........../.~..~... ..................................... 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, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........~...~..~ ........... Rear ......... ,.~.. ................ Depth ..,,7~...~. .......... Height ../.~.~. ............... Number of Stories Dimensions of same structure with alterations or additions: Front ........... ~..~. .................. Rear ...... ~....-~.. ............... Depth ........ ~.J.~ ................ Height ........ /.i~. ............... Number of St,aries ......../..~ ................. 8. Dimensions of entire new construction: Front ........... ./.~.~ ................... Rear · ' ...... ................. Depth ............. Height .......~.. .......... Number of Stories ...... J. ................................................................................ 9. Size of lot: Front ...... ~/~t,~.. .............. Rear ...... /.~,~.. ................... Depth ...~'.~. ..................... 10. Date of Purchase ........... ~.~.~'.~. .................................. Name of F, ormer Owner .~/~/.~../(J~. ....../~JNc'~lf.~.,~',~.i ......... 1 1. Zone or use district in which premises are situated ........... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .~/'~. ......................... 13. Name of Owner of prem,ses ..~...,~"~.,~......Axk:lress ~'~.~&~.~..~J.~.:..~/~.~...~.~.¢/~l~hone No.~.~.T.,~..~..~..~.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~-~J'A/~J~'y......~.~.~.'/'.-~. .......... Address ~.~.......~...;..j~'J.~.~.. Phone No~..:~..~...'~ .,~'.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~oock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. COUNTY OF ..~ ........ $~"/~ . (Norr~of !ndivid~al signing application)71 _..~_ _~ above named. He is. the ..................................................................................................................................~ · ~ntmctor, ag~t, c~rate officer, ~c.) ~f said ~ner or ~ne~l and is duly authorized to peHorm or h~e-~Ho~ed the said work and to ~ke and file is application; th~ a~ statements contained in this applic~ion am tree to ~e ~ of h s ~wledge and belief; and that the ~rk will ~ performed in the manner ~t fo~h in the ~lic~i~. fil~ t~i~. Swam to ~fom ~?his ~ ......... ............ ................ , // ' ................. .............................