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Home My WebLink About3264-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at . .~..~...1:~......~.O...~.~ ................................. Street Map No ...... ~ .... Block No ...... ~ .... Lot No ..... ~ .................. .~...a~..~.~.ff...u..q~. ~....~...Y, conforms substantially to the Apphcation for Budding Permit heretofore filed ~n thru office dated .......................... ~.t...O...~..~...~.. ~.~ ..... , 19. 6..~. pursuant to which Building Perm,t No .3.~..~.4.....~. dated ....................... .O.~.~..QT~:~.~...~,~....., 19..~..6..., was ~ssued, and conforms to all of the requirements of the apphcable prows,ons of the law. The occupancy for which th~s cerhflcate is ,ssued ,s ........ .................. ~..r.,t..v...a..t:...e.. ~.t:. a.c...h..e..4. ~..a.~..a.f[e. ..................................................................... The certificate is ~ssued to .............. .~.~R...~..~...~...~...~.~.~..¢~....~..1~.. ............................................................ (owner, lessee or tenant) of the aforesaid buildmg FORM 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) N? 3264 Z Dc~'e .......................... I~C :~.oba~"..... ~],..., 19...66 Permission is hereby granted to: ........... ~.~ep.ko.....~.C ................. ............. F~.t t.~-t~k ............................................. to . ~..).~..new.. 19~'~'~te'- ~ ge .............................................................................................. at premises located at ..........~/.~....~tl~,h...l~oe~....~jl~.~. ................................................................. ................................................... ~a~;ti.ttu~kt.. N. 1. ......................................................................... pursuan¢ to application dated ........................... O.(~t~ ....... ~ ............. , 19.~6.., and approved by the Building Inspector. Fee $..~,DO. ............ I ~ "~ Building Insp~:tor FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~amined ...................... ~,.:.. ............ ]9 ........ Approved ........................................ , ]~ ........ Permit ~o ................................ Disapproved a/c ............ :..y::;.:..~~~ Application No ........................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o Th~s opplicohon must be completely fdled m by typewriter or in ink and submit;fed in duplicate to the Buildir Inspector. b. Plot plan showing location of lot and of buildings on premmes, relationship to adjoimng premises or public streets areas, and g~ving a detoded descnphon of layout of propertymust be drawn on the d~ogrom which is part of thru applicoho, c The work covered by this opphcotion may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Budding Inspector wdl msue a Budding Permit to the applicant. Suf permit shall be kept on the premises available for ~nspect~on throughout the progress of the work. e. No building shall be occupied or used in whole or ~n pa rt for any purpose whatever until a Certificate of Occupant shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE lo the Budding Deportment for the msuonce of a Building Permit pursuant to t} Budding Zone Ordinance of the Town bf Southold, Suffolk County, New York, and other apphcoble Lows, Ordinances Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein describe, The opphcont agrees to comply with all applicable laws, ordinances, building code and regulations. ~--~ ~ Stanl y Sepko ,,~' /' G ,,~ ~, ~ r~ ,z ......... '~'~'~'~'~'J;~;'gf"~,~i;g~'~'C'~';'~'o'~'Z','~'~,"~g~'o';~;~i ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc ......................................................... Com.~.a~to~ ............................................................................................................ Nome of owner of premises ............................... Ja, skow£ak ............................................................................................ If applicant m a corporate, signature of duly authorized officer. (Nome and title of corporate officer) ,,,~ , SSSSS SS ]. location of land on which proposed work will be done. Map IN~: ............................................ Lot No: ................. Street and Number .......... ~.....~.~]g...~.O.~ ............ ~1~1~[~ Municipality 2 State existmg use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ......... ~Wf~],3,~k:D~ .................................................................................................. b. Intended use and occupancy .... ,.~.~..~.i.~h..~.v~..~e..~a~,g.e .......................................................... 3 Nature of work (check which applicable)' New Building ....... :Z~,,~K~... Addition .................. Alteration ............... Repair .................... Removal .................... Demoht~on .................... Other Work (Describe) ..................................... 4. Estimated Cost .~1,.~'.0. ............................................... Fee .... ~. .................................................................................. (to be pa~d on flhng th~s apphcation) 5. If dwelhng, number of dwelling units ............................ Number of dwelling units on each floor ........................... If garage, number of cars ....... .'L~ .............................................................................................................................. 6. If bus.ness, commercial or mixed occupancy, speofy nature and extent of each type of use ............................... 7. D~mensions of ex~stmg structures, if any: Front ..........................Rear .......................... Depth ........................... Height .......................... Number of Stories .............................................................................................................. D~mens~ons of same structure w~th alterations or additions. Front ................................ Rear ............................... Depth ............................ Height .............................. Number. of Storms ........................................ 8 Dimensions of entire new construction: Front .3.6 ...................... Rear ........ .'1~) ............... Depth ........ ~l~ .............. Height ............................ Number of Stories ...... .O~B ............... 9 S~ze of lot. Front ............................ Rear ........................... Depth ................................ 10 Date of Purchase ........................................................ Name of Former Owner ...................................................... 11 Zone or use district in which premises are s~tuated ......... !!~.!!..~l.J~S,f~ ................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulabon? ......... ~Q ...................................... 13 Name of Owner of premises .......... ~f~Q~.'i a,~: ........ Address ....~a.~.~J~;~l.~c ................. Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ..~.,~f~Q ................................. Address ....... ~a.~.t,~.~ic ............... Phone No ................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property hnes G,ve street and block numbers or description according to deed, and show street names and ~nd~cat whether ~nterior or corner lot. . STATE OF NEWsYORK. ~ COUNTY OF .... .............f S.S ............................... ~.t~e~/'...Se,~r,,o ....... : .......... : ................ being duly sworn, deposes and says that he is the applic( (Nome of individual signing application) above named. He is the ..................... (7~t~'~:e.~,~' ........................................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this apphcation, that all statements contained m th~s application are true to the best of his knowledge and bah and that the work wdl be performed in the manner set forth m the apphcatlon filed therewith. Sworn to before me th~s ..................... ~ day of ................ · . ...... ............... Nota~ Public, ...~...~~,nt~~(Signat:~f ~ Commission E~p~res March 30, l~