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HomeMy WebLinkAbout1028-zFO'R~ N,O. 4 TOV~N OF SOUT~IOLD SOD'TI{OLD, 1~. Y. No ...... .F.,_ ...8..5..? ...... Date .....................9~ ~ .°...b..e..~'... 2.(~ .............. 19...6...0. THIS CERTIFIES that the building located a~ez<~..~.n~.e..~_....L.~..n...e.~...~7..~.gr~P.9~.... Street Broom & ~L~vi~e !VIap No ....................... Block No......e...*...*. ........ Lot No .... .~*..*. ................................................................... conforms substantially to the Applie.ation for Bu~Idlng Permit heretofore filed in this office dated ................. ..A.??-i-~...-.9. .......... , 19..6...0_. pursuant to which Building Permit No ..... ~..1.9..2.~ .... ~lated ......................... Ap. ri~....9 ...... 19..6t)., was issued, and conforms to all of the requirements of the appiical~le provisions of the law. The occupancy for which this certificate is issued is ' This certificate is issued to Et/gene Bogashewicz, owlle= (owner, lessee or tenant) of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1028 Z Dote ........................... ,,~ J.~ ....... .~. ......... ] ~6....O.... Permission is hereby granted to: ...... ~..~.~..e..~...~ ............................................... .............. ~..,~.e.~.~.t~ ~ ........ ~ ~ ~ · .......................... to ........ ~.~..%~...~.~..~¢$.~.$..o.~...p.~..~....e.~.t.~g...~.e.~..z..t.~g ................................................. ct premises located at ...~..~.....J~.~-~*,~f~.~..,~.~ ................................................................................... ................................................... ~.e...e..~. ~.,o..~ .~..... ~....~. ....................................................................... pursuant to application dated ............................. ~..~ ....... ~.~...~..~.(}9 ........ , and approved by the Building Inspector Fee $ ..~',.0~. ............ Examined ...... '.~,....~..., Approved .................................... , FOKM NO. ! TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No ................................. Application No ....... .(..~...'~.~ ...... Disapproved a/c ........ ~~~22~: (Building InSpector) APPLICATION FOR BUILDING PERMIT Date ...................... ...... , 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 location. 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 shah 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 laws, ordinances and regulations. ...../.:.~.~.... ......... ~..z.-~.~:..x!..:~:ZC.~ ....................................... (Signature of applicant, or name, if o corporation) ......... .......... ................................ t (Address of applicant) .~t.~t.~..w.~iii. l.r.. :~.~.~.~.~i :.~iiii, ::ii[..~.~'.~:.: i.'..::~r.~,.. ~ ~t.i~i~i:' .: I.:il.r.'. i.'~:;..~i~..m.i~, r...~r.., b..~iI ~i; Name of owner of premises ................. ....... ..................................................... 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: ..~...~....~ ......... Lot No:..~...,~. .......... Street and Number ...~..~./...'~'.i...~....~ .......... ~.~ ..................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~~1. ' . b. Intended use and occupancy .................. ~.~ .................. ..~.~./....~X.~./~....~.'u.t'~ ................................... property lines. Give street and block whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ........... ~.....Alterotion...~ .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) 4. Estimated Cost ...... i~...~,...O. ....... ~ .......................... 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 ~u ~ ............................................................................................................................................. 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 ................................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ............................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~..'.~.'~ .................. Rear ~ Depth Height ............................ Number of Stories ....... ~ ...... 9. Size of lot: Front .......... ~..~. .......... Rear. '7~- Depth /~ O'/- 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zane or use district in which premises ore situated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ~ 0 13. Name of Owner of premises..~.~~c~ddress ...~: ................ Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from numbers or description according to deed, and show street names and indicate STATE OF NE~¥~Y(~BKa ~ ) S S COUNTY OF .,~,.~.~,..,) ' ' ....................... .......· (Name of individual signin~-'application).m above named. He is the ...................................... ~~~ ............................................................................. (Contractor, agent, corporate, officer, etc.) of said owner or owners and is duly authorized to perform or have performed the said work and to make and file this application; that al( statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in~ll~l~t:r~.a~}~l~1 set forth in the application filed therewith. Sworn to before me this ~' ~'~,,~,, ~:,~i;~"~'x~il;~r:sS~l'r~'~, ~:~,?g&! ...................... 7. o o, ...... ............ .... (Signature of applicant) Examined .............. ~) .................... , Approved .................................... , I~OEN~ NO. I TOWN Oi: SOUTHOLD BUILDING DEFA. RTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ('° O 19 ........ Permit No ................................. Application No. / 'b -~ ~ Disapproved a/c t ~ ............. ...... ....................................... (Building InSpector) 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 locution of lot and of buildings on premises, retutionship to adjoining premises or public streets or areus, and giving a detailed description of layout of property must be drawn on the diagram which is port of this locution. c. The work covered by this applicution may not be commenced before issuunce of Building Permit. d. Upon approvul of this application, the Building Inspector will issue a Building Permit to the upplicont. Such permit shall be kept on the premises ava,liable 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 u Certificute of Occupancy shall huve been granted by the Building Inspector. APPL CATION IS HEREBY MADE to the Building Deportment for the issuunce of a Building Permit pursuant to the Building Zone Ordinunce of the. Town of Southold, Suffolk County, New York, and other app icab e Laws, Ordinances or Regu arians for the construction of buildings additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply w th all applicable laws, ordinances and regulations. (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. Name of owner of pram'sos .................. ~ .............................. -.~, ~.~.~.K~¢.,~......¢,~..~,,~-- .................................................... ff applicant is a corporate, signature of du~y authorized officer. (Name and title of corporate, officer) 1. Location of [and on which proposed work will be done. Map No: ~¢:~:~ ~.z~ ~i~ ....... ?~, . Lot No:.....Y....~.~ ......... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ......... ..z~..'.~.~.~.?.'fl "~'"'~' ............. f'"':t ................................................................. b. ~ntended use and occupancy ..................... : ............................... :.2'.. :.'. ............... , ............................................. 3. Nature of work (check which oppli'cable): N~v Building .................... Addition ............ ~.Y'.;.....AIteratior~..,,~ .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost /. [~' ~ ~ ~ ..... Fee · (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ K~.'~..~.'..~-.....Number of dwelling units on each floor .................................. 6. If business, comrnercia[ or mixed occupancy, specify nature and extent of each type of use ....... m~x ................... 7, Dimensions of existing structures, if any: Front ............................ Rear ............................ 'Depth ................................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........................ Rear ........... /. ............... Depth ............................ Height ............................ Number nf C[tnrs~q ~,T 9. Size of lot: Front ........... .7..~'~. ......... Rear ......... ?.~.~. .......... Depth ./ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. 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 premises...,...¥.4rm, m.. ddress ..... ~, ...... ~ ........................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor ~xe .... (~,,.=~.¢~ .,,~,.~ ............. Address ';¢, -~. ~.,Z.,l ........... Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEk¥)Y~,Ko,~/ ) S q COUNTY OF ..'~...~]~.;~. ....... ,~....) d y sworn, deposes and says that he is t e apphcant above nam(Ne~lm ign (Contractor agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said wor¢ and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the. work will be performed in the manner set forth in the application filed therewith. ........................ day of ........... ~ ................. , ....... 19 ............ ...~.~.~ ~ nt Notary Public, . ..,u~., ~-~'...... Cou y (Signature of applicant)