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Home My WebLink About7306-zFOB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'~ Office $outhold, N. Y. Certificate Of Occupancy No. Z611 ~. ...... Date ............ ~ept.. 't? ...... ,19. THIS CERTIFIES that the building located at . l~eak~ate.~ .Roa6 ........ Street Map No. -xx .........Block No..xx .......Lot No. :~r~.. lJatt~,tu~k- · .~ ,~., ......... conforms substantially to the Application for Building Permit heretofore filed in ~hi.~ office dated ..........gm~e..7 ...., 19.?b~. pursuant to which Building Permit No. dated .............June .. ?.., 197~.., 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 .Fr.~.vate. o~e. ~mi.l.l~ .dw~.lL, tg. ~.th. ~n .&dd4tio~ .................. The certificate is issued to .Fr~_n~ .ltg~e~k ..... ¥~m®l* ............................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval .Il oI~.. .............................. UNDERWRITERS CERTIFICATE No. N oI~ ........................................ HOUSE NUMBER .............. Street .......................................... Building Tn.~pector FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPA~?MENT TOWN CLERK'S OFFICE ~OUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7306 Z Permission is hereby granted to: ..... F. rar~..~ak ...... , ........................................ 14~.tt~tuek to .Sul3A..a~ilZlcm..oz~.a~Ls:J~&..dw~].llai ....................................................................... at premises located at ~/~....&l~t~:~.,~d.-.(-~z~e~te~..~...) ................................................. .................................................. J~at~lt~k ..................................................................... .......... ' ....... pursuant to application dated .........................J%l~e ....... t~ ........... , 19.~1t.., and approvec~ by the Building InspecfOr. Building ]l~sl;mctor BUILDING DEPARTMENT TOWN CLERK'S OFFICE · )U'rHOLD, No ¥. £xamined .................. , I ~....~... ........................................ . ,',rm,t,o. ...... Application No ..... Disapproved a/c ................................................ ~ ....... (Building ~ APPLICATION FOR BUILDING PERMIT /~ '~ ............ ......... .......... INSTRUCTIONS . ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildlng.1 Inspector, with 3 sete 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 o~ areas, and giving a detailed description of layout ofpraperty must be drown on the diagram which is port 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 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 Bu ding Department for'the ' ua ce of a Budding 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 or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~.~..e'...,~....~.~?~ ~'A ,,,9~ / ,::~ .............................. ~..Z".~. ...... ,,..A./., (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ~.~....~,~ ................................................................................................................................................ Name of owner of premises ........................ ..~..~.f~..~.....~....~'..,~..~.~.. ........... If applicant is a co~omte, signature of duly a~horiz~ officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of and on wh ch proposed work w be done Map No ' · .: .................................. v... Lot I~o ......................... Street and Number ............ ~,,..-:..~.cr..~,,./z;..v....xl..//'.. .......... .~:-..?...?:.~t~. .~~ t~¥O Q ~-,q ~ ~x~qT' £ '/~ '~0 ~ 'r~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................ ~..~.~.~-. ........... . ....................................... b. Intended use and occupancy .............. ~ ...~...~. ~....l~c.....~..~ .................... ~ ~}qature of work (check which applicable): New Building.. ................. Addition .................. Altezgt,on ................. Repair .................. Removal .................. Demolition .................... Other Work ......~...........~.....t~.....~....~..~.... (D~ription) o 4. ~timated Cost ............................................... Fee ...~ ....... ~ ................................................... ~; ................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ .................. Number of dwelling units on each flor ........ ~ .................. If garage, number of ~m ~ ............ ~. ............ ~ ............................................................................................................. 6. If busings, comme~ial 0r mix~ occupancy, spec~ngture and extent~h ~e of use ........ .~.~.~ ......... 7. Dimensions ~ting structures, if any: Front '"'7 .................... Rear ................................ Depth ....... ............. Height ........................ Nu~er of Stori~ ............................................... ~.~..~ ................................. ~..~ ........... Dimensions~a~e stmctu~ with alterat~ pr additions: Front ............... ~..~...~.~R~r ............................ Depth ......~ ........................ Height ............................ Number of Stories ..........~.~ ................. 8. Dimensions~ e~tire new construction: Front~ ....... ~..~.~.~.~. ..... Rear ............................ Depth ........................ Height .................... Nu~ebo~St~ries '~ ....... , ............................. '~"~O'"" ................................... ~'~'~'"'~ ....... . Size of Iot'..~Fr~t ~/__~~ ~ ....... ~/~... Rear ............................... ~ ~e~ '~'~'U"~'" 9. '1~. Date o~ Purchas~ ..... ~......~ .......................................... N~ of~grmer ~ner ........................................................ 11. Zone or u~ district in which premises are situated ..................................................... ~.~ ......................................... 12. D~s proposed constructi~iolate any zoning law, ordinence or regulati~: ............... ~ ................. ~ .................. 13. Will lot be r~raded .............~..~ll ~~remov~ f~e~ (~ 14. Name of ~ner of premises ................................................ A~m~ .................~ ............. ~ No ................... Name of Archi~ct ...................... ~ ....................................... A~re~ ...........~ .................. Ph~e No ....................... Name of Contractor ............................................................ A~re~ ................................ Ph~e No ....................... PLOT DIAG~M ~cate clearly and distinctly all buildings, whether existing or proposed, and indicate all ~t~k dimensions from prope~ lines. Give strut and bilk number o.r description according to de~, and show street names and indicate whether interior or corner lot. STATE OF N~R~,/ ~" Icc COUN~ OF ~....[~'~ .................. ;Z;.~N~_;...~.2.~; .............................................. being duly sworn, d~oses ond seys t~t he is the ~pplicem ~o~e ~dividuol signing c~tmc~ obove nom~. ~ He is the ...... · .............................................................................................. (Controctor, ogent, corporote pfficer, etc.) of se d owner or owners, ond is duly outhorized to perform or hove performed the sold work ~nd to ~ke end file this opp c~t on; that o I stQtements contained in this o~licotion ore_t~, to the best of his kn~ledge ond belie~; end tho~ t~e work will be performed in the monner set ~o~h i~ t~e opplidot on fi ed th~r~it~. Sworn to b~ me this ~ yof, , ............................................... ................................................................................................. (Signature of applicant) JUDITH T. B©K~N No oM Public, State af New York No 52-0344963 Suffolk Count Commission Expires March 30, ~'