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HomeMy WebLinkAbout5763-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No .... 55385 · · · Date ............ August..1.5, .... , 19.73. THIS CERTIFIES that the building located at Kenny. Road ................ Street Map No..2180 ....... Block No ..... XX ....Lot No..PT..19- &- .2g .................... conforms ~ubstantiaily to the Application for Building Permit heretofore filed in this office /~at~d/ ........ March. 24., .... , 19 .7.2. pursuant to which Building Permit No. 5.7.63Z.. / dated ........ I~arch. 24., ..... , 19~.2.., 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 ~.~iva. te · one. family, dwel/~ing ....................................... The certificate is issued to .... Richard. Grigonis ..... . ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER . 22.25 ........ Street .. Kenny. l~ad ............................ .............................................. So~thold ~. N..X .................. ...... ....... Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5763 Z Permission is hereby granted to: ..... ~..~..e.....~..,,.~e.~....m.~ams, pursuant to application dated .......................~ ....... ~1~. ............ , 19~..., and approved by the Building Inspector. Fee $,~.~..fl ,(~. ............ Building Inspector Approved ......................... ~.~ ............ , FOR, n~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE souT.o o, ,. .... ^pplicotion No. ~'~ Disapproved O/C .... ~.~.. (Building Inspec(or) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector. with~c-. 3 sets 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 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 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~J 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 inspectors on premises and in buildings for necessary inspections. State whet~r applica~t is owner,'lessee, agent, 'thitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~.~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 2. State existing use and occupancy of pre,~an~d~nt~ended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration...../....~. .... Repair .......................... Removal ......................... Demolition ........................ Other Work .................................... / ~,*-~(~. {Description) 4. Estimated Cost ............ ~..?.~.~....-~.. ............. 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 cars ............................................................................................................................................ 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 ........................................ Rear ....... ,~....~'.. ........... Depth .....~.. ........................ 8. Dimensions of entire new construction: Front ..... ~.,....../. ......... / Height ................ ,(... ............................ Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. 12. 13. 14. Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ Will lot be regraded .......... ~: .............. Will exce~s fi}l be removed frommfemises: [ ] Y~s [ ] I~ Name of Architect ................. ; .................................. ~ .......... ~;~.~ ............................... ~;.~ ............... Name of Contract~~.~~...~ ............. ~.~..~..~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. S'rATE OF NEW Y[31~Kt ,/j ~ ~, ) ~ /' ............................. ~~, .,~.~.C-~..-.~being duly sworn, deposes end says that he is the applicant above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorizll~ to perform or have performed the said work end to make and file this application; that all statements contained in this application are tr~,~tl3~bt~ of his knowledge and b~lief; and that the work will be performed in the manner set forth in the application filed therewith.~'~?% ~* ~o ..................... ................ . Notary Public, ~.,~....~...,:.~~ Count~ ~,~ .~ ........................................