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Home My WebLink About5723-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.~.~.7.~ ..... Date ......... 0c.tober..18, ...... , 19 THIS CERTIFIES that the building located at .S/S J. ackaan, at~eet ...... Street Map No .... ~ ....... Block No .... XX .... Lot No. ~.~. New. Snf£olk ............... conforms substantial]y to the Application for Building Permit heretofore filed in this office dated ......... ~qept-o..27~.., 19. ?3. pursuant to which Building Permit No.. .,~/ed ......... Sepf,...27~ .... , 19..7.1, 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 ...t~iva. te · ga. rage.· (.acces zo-~y, bldg.).. · Ap.pr. oved .by. Bd .. Appeals.. The certificate is issued to .. F.~ar~k..P.. Geh~'in§ .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .. ~I.R, ............................ UNDERWRITERS CERTIFICATE No .... ~Ni~I~(G ................................. HOUSE NUMBER .... .ll~0 ..... Street .... ~.k..s0D..S..t.~.e.e.t. ..................... ............................................... .N.ew..S..uff. .................... Building Inspector FORM NO. ~ 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) No. 5723 Z Permission is hereby granted to: ....... I~e.t,t..'llte~ ................................................... at premises located at ........ ..J.~....~.~..l~..~ ................................................................................. ................................................. I~... J.~.~'ml, k ...... I[.~.'. ..................... : ............................................. pursucuYc to appJication dated ............................ i~lJJl,....JJJ .......... , 19..ti1~., and approved by the Building Inspector. Fee $ .~,e, O0 ........... [ ' ~ui[aing ~n~cror / FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLIRK'S OFFICE SOUTHOLD, N, Y. 19.7~.. Pemit No. ~..- .~....~--...~.....~.. ............ Application No......'~...Z...~...~... ............. APPLICATION FOR BUILDING PERMIT ~ ~- ~ate ~.-. ~,'Z. ...... ,~..7/..... 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 Laws, Ordinances or Regulations, for the construction of buildings, additions o~ alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bui/l~ code, housi/o~od~ regulations. ~ ~ ~---~ ...... ~/./.~..~.~~~....~ ~~ ............... '~ (Sig~-,j~Te of applicant: ~ name, i~'~;~tion) ' ~ . ..~.?_. ....... '('~;~;i;';;'~';;~';;~i;;;;;;~i ............................... State whether applicant is owne~, le_ssee, a;e~,'~'~..~itect, ;~/gi~ee, g~-'/~eneraJ~c~nt~lectrician, plumber or builder. ...... ~..~.~...~.~, __ . : .. . ............................................... ~>..~ ~ ~~;.;;Z~ .~ ~ ......... ~; ................................................. ~ ................................. ,ome o' owner o' ...... ......................... If applicant is a corporate, signature of duly authorized officer. ' 1. Location of land on which p?~_ osed work will .be done. Map No.: .................................... -~ot No......~"... ............. Street and Numar ......... .~.T...~ .......... ~.~.~..e ........... J.~..~..~.:.~ ....... ~.Z...,. ............................................... Municipality '"~' 2. State existing use and occupancy of prem,~ intend, ed use and occupancy of proposed construction: a. Exisiting use and occupancy .................. .,~,..,,?~, ../...~..~..~...~..,,~,. ................................................................................ b. Intended use and accupcmcy ................................................................................................................. .~..,. ...... 3. Nature of work (check which cable): New Building .................. on .................. Alteration .................. Repair ................ sC.~lt~,emoval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~,..i...~.~...~.. ................................. 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 ...........~1~....0. .......... :. ........................................................................................................ 6. If business, commercial or mixed occupancy, specify natg~'e and extent of ¢¢ch type of use ..... ; ................... 7. Dimensions of existing structures, if any: Front ..... .~..~/~..~. Rear ...~...~[~.~.. .............. Depth ...4..~..~. He ght...~.~.~. Number of Star es ........ .~...~...,~,. ............................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of. Stories .............. ._. ........ D ensons of ent n onstructon Front "~..~. ~....~. R c~'/'/T/~" '- ~')~/- 8. m r~[e iew c : .~). ........................ ear ................... v...',..., ueprn ..................... Height .......L,~......2~. Number of Stories .............. ../~.....~.~..m .............................................. .~. ....................... · . )-£4¢ J ,F. ,,f- . ' ........... 9. Size of lot: Front .......~....~.. .............. Rear .....Z~.. ........................ Depth ......~..: .......... .~.~.......~ 10. Date of Purchose~...7...../..~...~..¢ ...................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated .....~.,~z~..~./21~.¢~. .................... ; ........................................... 13.12' Name of Owner of premses''~''''~q'-''?.-~/-''-K'. '_ /~'~...~.~...-~Ane 7'~.~..~...~..?...b/.~ Does proposed construction violate any zoning law, ordinance or regulation.;> ............................................................ - .~- · ~..~../. · ./~..~.. Add r es~....'~. · .~../~....'~...'~. · ................ No .................... Name of Architect ..... ~ .............................. / Address ........................... .~ ............... Phone No ..................... ~L ~ Name of Contractor ~..¢',¢~ ................... Address ....;~..~. ..... ~.~..: ...................... Phone No. ~/~r ~ c/(' ................. PLOT DIAGRAM Locate clearly and distinctly oil 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 a~l indicate whether interior or corner lot. ..LOT' [_ ¢1,, * / .,STATE OF NEVY, YQJ~K, /~ J S e COUNTY OF~ .......... (Nome of individual signing t:lt~plication) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, otc.) of said owner or owners, and is duly authorized to perform or have performed the said work and t~,rr~ke end file this application; that all statements contained in this application.are trg~t?tgke best of hJs.~fm~le~l~e~and belief; and' thosthe work will be performed Jn the manner set forth in the application' filjicl thJe~,.~4th. Sworn to before me this ~ / /~dr- ' / // .... ..~.....?,....m.. ....... .day of ~-~,~ ,19 ...... ~../. (~"////b~. ~ Notary Public~,c~r~......~.... County k..s.~// (Signature of apl~cant) ~.N~ W. J~CO.S // / - 1 ¢ / Notly Public in State of New York// 1 No. 52-7057150 Residing in Suffolk County Commission Expires March 30, 1~