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Home My WebLink About5951-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's OfFice $outhold, N. Y. Certificate Of Occupancy No.. Z~6~ ..... Date .......... ~etob. er. 1B.~ .... , 19.73. THIS CERTIFIES that the building located at .. ~ta .R:L~ .1~9~ ..... Street Map No .... ~ ....... Block No. ~ ....... Lot No...~... ~U~l~ ............... conforms subst~ti~y to the Application for B~ld~g Permit heretofore ffl~ M ~ office dated ....... J~e .16~ ..... , 19..~ p~su~t to wMch Building Permit No.. ~. ~ated ........ ~ -1~ ...... , 19..7~ was issued, ~d conforms to aH of the req~e- ments of ~e applicable pro~sio~ of the law. The occup~cy for which ~is ce~ificate is issued ~ .-~vate. ~ees~. ~l~ ....................................... The certificate is ~su~ to .. ~der..~~ ............................ (owner, lessee or ten,t) of the afores&d b~ldMg. S~olk County Department of He~th Approv~ .... NcR · ........................... UNDERWRITERS CERTIFICATE No...N,R, ...................................... HOUSE NU~ER .... ~ ....... Street .... Ri~. ~ ...................... ............................................. ~m~o ~ ......................... ...... ~l~i~~r ............ 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) 5951 Z Date .............................. ~'.~J[~ ............ ..J.~, 19..-....~2 Permission is hereby granted to: ....~.l~..J.~a~k ......................... to ....~..ma..a~.~or~.-Ir'~..-(l~l;~s~'..hou~')' ....................................................... et premises located at .......... ~...~JJll~.J~ ........................................................................ ....................................................... ' ........... OeJtiJo~l .......... I1.~'~'~ ........................................................ pursuant to application dated ............................... ~lllll~.....J6....., 19...~., and approved by the Building Inspector. Fee $ .~.O~X). ........... Buildihg BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. Exomined . .~.(.~......, 19 ........ __ ..: ...................................... Approved ........................................ , 19 Pemit No ~~ Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT ~) ............. ............. , ?2 · .. ]9 ............ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~. 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 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 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 beent 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, building code, housing code, and regulations, and to admit authorized inspecte(r~ on premises and in buildings for necessary inspections. Alexander Bondarchuck (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee~ agent, architect, engineer, general contractor, electrician, plumber or builder. Owner - builder Name of owner of premises ...~3-e,~{~C],~.l::..~.oz;~a,Z'~.hL~ ........................................................................................ .~ if applicant is a corporate, signature of duly authorized officer. ~ ............ ......... ..................... - " 1. Location of land on which proposed work will be done. Map No.: .............................................. Lot N ... · /G Richmond Road ...S.o.,.u..t...h..o..1...d.......N....Y..., ................. Street and Number .......................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~..w...e.~..~.~..T[..g; ............................................................................................................... b. Intended useandoccupancy ............ . -~ : 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. · Repair ......................... Removal ......................... Demolition ........................ Other Work .... (Description) - 10.00 ........................... 4. Estimated Cost ........................................... i... Pee ...................................................................... (to be paid on filing this application) B. If dwelling, number of dwelling units ....0. ........... Number of dwelling unitS on each floor ......................................... If garage, number of cars .;.....; .................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ..., ................. Rear ........................... Depth ............................ t....;. 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 ....... b~o!! ........... Rear .......... ..b¢~ ............ Depth ........... .60.~.t ............... 60" Height ................................................. Number of Stories .........o..~.,e. .......................................................................... 9 Size of lot: Front .......................... Rear ...... Depth .................................. 10. Date of Purchasa ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premisas are situated 'qLn 12. Does proposad construction violate any zoning law, ordinance or regulation: ......... ~o. ............................................. 13. Will lot be regraded ...... nO ...................... Will excess fill be removed from premisas: [ ] Yes [:x] No 14. Na me of Owner of premisas ......A'~q,~.....~t.~;~.. ~.O~'I~.~1~,LLQ~ ................................................................................. (Address) (Phone No.) Name of Architect .................................................... (Address) (Phone No.) Name of Contractor ....~.~,]~.e. ..................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposad, and indicate all sat-back dimensions from ~mes and indicate wheth- property lines. Give street and block number or description according to deed, and show street r er interi( ' or corner lot. F NEW YOR K, ) OF .....~1,~_¢,0..~ ............................. ) STATE (3 COUNTY .............................................. · .'~..~.~...~.~z~,¥.h.....~..¥.~z .~..~...~..~.~..~.~. being duly sworn, deposes and says that he is the applicant above named. (Narae of indivi~ si~ing con~act) He is the .................................................................. Q~9.~...=.;.~.~ ...................................................................................................... ( Con~ctor, ~t, commie o~r, etc.} of said owner or owners, and is duly authorized to ~rform or have ~rformed tbe said ~rk and to make and file this appli~tion; that all statements ~ntained in this application are true to ~l~s~.~nowled~ and ~lief; and that the work will ~ ~dor~d in the ~nner ..... Nota~ Public, Stale of New York ~t forth In the apphcat~on filed t~rew~th. No. 52-0344963 Suffolk Count ......................... ....... % ...................... ................ ..............