The URL can be used to link to this page

Home My WebLink About3543-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~.. ~.0.~.0 .... : Date ...............~l~l~h..~.., 19.~ THIS CERTIFIES that the building located at 1~ .][~d~ .~,J~/~ .6. J.~ ...... Street Map No.~hblr...(~[k~,k No .... xx ......Lot No. ~ .... Gl'aenl~t~..~,Y,. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~.tl~r...13 .... , 19 .~. pursuant to which Building Permit No..~.~3 .~. dated ......... ~,..1a ..... ,19. ~., 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 1~t~ .o~ .fa~.y./[~!I~ ....................................... The certificate is issued to ./i.~.~.~..8~.~ ........... ~1~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Building Inspector' ~oP~V~ NO. ~ TOWN OF SOuTHOLD BUILDING DEPARTMENT TO'WN CLERK'S'OFFICE SOUTHOLD, N. Y. ~ : BUILDING PERMIT' , ~CI'HIS PERMIT'MUST BE KEPT/ON THE RREMISES UNTIL FULL CQMi~LETION ~OF THE; WORK AUTHORIZED) :,, N? ~,3543 Z to,, ~,.~:.-~..~..~;~, .................... , ....... ~....: ................ ~.,~ ........................... at premises ~ated at. ~ ~,i~.-~ ~,.~ ~ ~: ~ ~. ~ ........... ~~,,.;a,,~...:la~..~).....:..~ ..... · .............. :~ ............... ..,.,.,~ ::.. : ~~""uuna~ng' -~nspector. ~' ~, . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. 19.~..i~... Approved ............. ~/ ~...~, ............. ..~.. ...... , 19.....~... Permit No. ....... 3 /~-/-7/~'~........,............~ Application No....~.,....~,,i~i~. ........... APPLICATION FOR BUILDING 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 of property 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 o 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 or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code and regulations. Stanley Skrezec (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ ..................................................................................................................... Nome of owner of premises ....S..~..~?r..~..e.z...S..~2.r..e..~.e...°.....~...?!i$.~..e. ............................................................................................. If applicant is o corporate, signo,ure of duly authorized officer. (Name and title of corporo,e officer) 1. Location of land on which proposed work will be done. Map No.: _..~..~.?.l..b.~. ........ ' ................. Lot No.: ...~-~...~.. Street and Number ~..~...~...~..~.~.:p~?.~.~.e.~.~.~.~.~.~.~.~.~S.~-.~..]2..~.S~.~..~..z:.e.~.e..~.~g..~..~ ............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~g..~..~.:.b.....]...o..~. ..................................................................................................... b. Intended use and occupancy ......... P~...~c%r,n,;~J],3'...¢,~.fl~L~,I).g .......................................................................... Nature of work (check which applicable): New Building .... ..~...~ .... Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) Esti~nated Cost ..~..~..~...~./,~ ......................................... Fee ....]:.0..."..0..9 ............ I (lo be paid on filing this application) If dwelling, number of dwelling units ....... .o.~..e. .............. Number oJ: dwelling units on each floor IF g?rage, number of cars ............... 0. Tk¢. If [~usiness, commercial or mixed occupancy, specify nature and extent of each type of use Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dirrjensions of same structure with alterations or additions: Front .................................... Rear · Depth.,q ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ............ 66 .................... Rear ............... 66 ......... Depth ....2~8 HeiJ~ht .................... Number of Stories ..... .o..~.~ ............................. Size of lot: Front ....... 8.7. ................ Rear ..... 300. ....................... Depth ...... ~.5~...,L.'12.)+.,,6 (ocl. cl. shB.~0e ) Date of Purchase ........................................................ Name of Former Owner Zor~e or use district in which premises are situated ~Att Doet proposed construction violate any zoning law, ordinance or regulation? ......... :DP. ......... Na~e of Owner of premises .~.~.~..~J~fz'.flT~.e.~...Address ..... g.:~.~QZ'.~ ................. Phone No. Narhe of Architect ...................................................... Address ............................................ Phone No. Na~ ~e of Contractor ...... ~.~.m_..e. ..................................... Address ............................................ Phone No. 12. 13. property I whether in STATE ( COUNTY PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nes. Give street and Nock number or description according to deed, and show street names and :erior or corner lot, NEW YORK, ~ ,. ,. 0 ~'~' DF ... ~.~;~.~?... ~-~ ............ of said o~ this appli, that the ~ Sworn to t .............. ~..~.~.~..e.~..¢..~..]-.~.e..~¢..O. ............................. being duly sworn, deposes and says that he is the applk [Name of individual signing application) abow,~ nar~ed. He is the .......................... ..0?f~...e.z'....-....~..g,$~..~p..~. ........ (Contractor, agent, corporate officer, etc.) ,her or owners, and is duly authorized to perform or have performed the said work and to make and :orlon; that all statements contained in this application are true to the best of his knowl, ge and belie{ ork will be performed in the manner set forth in the application therewith. Notary Pu~llc, efore me this .....~.~. day of ...................... ..~.?;.]-..~ ............ , 1 HOTARY PUBLIC, State of New Yor~ J',lo. 52-3~33120 Suffolk County~ ,Term [xpires M. arch 30, 19J~ nature of FOI~I NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ' · 19 ........ Approved ........................................ , 19 ........ Permit No. "; Application No..:.:..: ..... :=: ............ APPLICATION FOR BUILDING 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 of property must be drawn o0 the diagram which is part of this appliciation. c. The work covered By this application may not be commenced before'is's6ance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a B'uilding 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 o 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, end o'ther applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for reFnoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building .~ode c{nd regulations. Stm le k ezee . / (Address 6~ applicant) State whether applicant is owner, lessee, agent, architect, engineer, ger~ral contractor, elec~r~ician, plumber or builder. / Name of owner of premises .~..~.~,~.~f~...~.~.~.~D.~...~ .~.~,~..~. ........... r ....................... .~ ................... ~...: ......... If applicant is a corporate, signature of duly authorized officer. , (Name and title of corporate officer) ~ : ~ 1. Location of land on which proposed work will be done. Map No.: ...~J~.~]9~.$.1.~ i~ ................... ;(Lot No.: Street and Number ...~...~..~..~.:~.~.i~ft..~..~.~..:6[~(.~.*-~..$~.....(}~.~.~....~ ....................................... '~ '~ Municipality 2. State existing use and occupancy of premises and intended use and ofc(.Gpdxncy of pr~posdd construction: a. Existing use and occupancy ...... .~.~.g.~1~..,~,~ ........................... r,....~.M.; ............... , ....................................... b. Intended use and occupancy ......... D~f~...;J,~.~,].~,..~'I,~'~,~.....i~,. .......................... ', ................................... Hei~lht .................... Number of Stories ..... SiT,of-- lot: Front ....... ~.~ ................ Rear ..... '].O0 ....................... Depth ...... 9. 10. Datj~' of Purchase ........................................................ Name of Former Owner 11. Zode or use district in which premises are situated ....... 12. Doe~ proposed construction violate any zoning law, ordinance or regulgtion? ......... 13. Name of Owner of premises .~l~l~tl.e.~..~j~.~.~,~e...Address ..... ~~ ................. Phone No. Nolne of Architect ...................................................... Address ............ ; ............................... Phone No. Na~ne of Contractor ...... S&I~. ............. ~ ...................... Address ............................................ Phone No. Locat property l whether i'n Nat ~re of work (check which applicable): New Building .... ~X:t~.... Addition .................. Alteration Rep ~ir .................. Removal .................. Demolition .................. Other Work (Describe) (to be /~aicJ on flung this application) I[ c~welling, number of dwelling units ....... OJl. e .............. Number of dwelling units on each floor If gjarage, number of cars ............... alii If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use Dir~ensions of existing structures, if any: Front ............................ Rear Depth Height ........................ Number of Stories : Dirrjensions oF same structure with alterations or additions: Front Rear DeP.,th ................................ Height ............................ Number of Stories ................................ Dir0ensions of entire new construction: Front ............ 6J~ ................... R~ar ............... ~r ........ Depth ....j~ .......... PLOT DIAGRAM ,~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nas. Give street and block number or description according to.deed, and show street names and indi~ :erior or corner lot. STATE OF~ NEW YORK, '~ 1 ~ ~ ................. I; .............. J~l~lQ].6t~'...~,.~.e~; .............................. being duly sworn, deposes and say~ that he is the appli ' .(Name ofqndividual sigMng application) above n~ ed. He is the ..,.;..? .................. ~...~..~l~e~ / ~¢ ~ (Cont,r&ctorj'agent, cdrporate officer, etc.) of said o~ ~er or Owners, an~ is duly authorized to perform or have p~rformed the said work. and to make and this appli~ ~tion; ~hat all etatements contained in this application are t'rue to tBe best of'his knbwl, ~ and belie that the ~ .rk will/~be performe~ in the manner set forth in the application f ' herewith. Sworn to ~ ~fore ~te this ' ................ ............ ........ ............ ,:/~ . ~ ~ ~ .....,~ ~ ~ , ~,. ........... ~.~. Notary Pu~lic,?.L./.~..~..."~)~ .......... County -- , rn~lure of appli,~ ( I'?' ~ MARION A. REG[N[ ' // ',l ~ ~o. 52-3233120 Suffolk Cour~ L ~erm ~xp es