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HomeMy WebLinkAbout7910-zFOB,M NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z?~9 ..... Date ............ gal' ..... I, ...., 19.77 THIS CERTIFIES that the building located at .. 'N/S ~af~n Road ......... Street Map No.. ~ ...... Block No.. ';r:~: ' ' · Lot No .... ~Dc' ' 'l~t~ff~2t~kf ............. conforms substantially to the Application for Building Permit heretofore fried in this office ~_.~.._.~<lated " ge,~ 9 , 19 7~' pursuant to which Building Permit No. 7910g · ..~-~----'da~ed "' Ytay 9"" 197~.., 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 P~iva~:e one family .dwe~-2ing ~r~-'~h. a~diti-on ...................... The certificate is issued to E~a~cl. K~uge~- ...... (h/ne~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~-,'R ~ ......................... UNDERWRITERS CERTIFICATE No. pending .................................... HOUSE NUMBER ' "~9'1 ~Y" Street .... $~.eAn' 'Road'" 'Y~'ggi~;lz'el( ............ ...... Building Inspector FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7910 Z Permission is hereby granted to: ..lgl.~.. ~T.a,~b.a .... J~.C..]~,~ ..X'agle~...& W. to ..b~.. ~. ~i~i~..~..e~t~g.. ~w~ll~ .............................................................. ~ premises ~o~ed m "%9't'~ ......... ~"~ .............................................................................. ..................................................................... ~%t'~t~"'"N'~'~'*' ................................ ~ursuo~ $o c~pl~coHon doted ....................... ~ ....... .9 ................ 19..~., ond o~Droved by ~e Bui~din~ Fee $...t~00 .......... ~o~c~ L. Bergen N 8I°~. m N 86o43'00'~/~ 63 O( ROAD (N.YS. N s~ ~%~p 'w t~ 8~o58'5o,,w lul o ,qte. 25) REVISIONS YO 40'00STRANDEF ALDEN W YOUNG SURVEY FOR: EDWARD E KUGLI AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK CO, N.y. SCALE: [": /,.;~,- / / Examined ....... ~E.d....~.. -.......~......, 19,~..~... ,! ,,,~proved ............................... ..L..., ~gZ..~.... Pem, t ~o ................... ........................................................... , ...................................... .................. ......... ............. o - ..... ~ ' (BuiI~ I~to~ ...... v APPLICATION FOR BUILDING PERMIT ............. ............ . INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Bull Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of areas, and giving a detailed description of layout ofpraperty 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 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. V 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 inspectors on premises and in buildings for necessary inspections. (Signature of applica_ry,._o~..me.~.~ a, ~:rl:o,, ration) .......L...~._. .......... 'i~'~i'~i~i ....... '~" ................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ................ ::: .......................... , ..................................................... Name of owner of premises ....~::T...~......~...~...~......../...-L~.....~....~......~.~ ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. t , ~. - , Electrician's License No .... .~--^ ...... ~..~.....-.~'.~-!.~.~..-.~..-~'( Other Trade's License No ............................................... ~ / Location of land on which p. rcjposed work,w~l be done. ,/~Aap No.: ......................... i .............. Lot No..L ............... ~ ..... Street ond Number ....... ~..~./...../~........,~,,,/,~...'. ........ ~./~..~...,r.~....,.~....~.~ ......................... : ................................. State existing use and occupancy of premises and intended et~1~d occupanc, y/gf proposed construction: o. Exisiting use and occupancy .......... -- "--" /~ //~ Z....~../~....~-)....~...~.......~../.../../.....'~...~. ............................................. b. Intended use and occupancy ........................ -- /// ..~../........~...d.~ .................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. l," Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ,/,~/~. /.~' ..~ (Description) 4. Estimated Cost ....................................... ~:,,.. Fee ........ c...~-. .......................................................................... (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 ..3..~ ........... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................... 0 ............ ! 8. Dimensions Of entire new construction: Front ..... ~1~- ........ ~ ............... Rear ....... /'..~.. ............. Depth ...*~..~.'' ............... Height .......... Number of Stories ...4~.)...~..t .................................................................................... ~ ............ Size of lot' Front .~. ! Rear ~ ~ De th ,~-~,-~ '-- ..~...1~" 9 ........ ~ ................................................................................... p ............................. 10~ Date of Purchase ........................................................ Name, of ~:ormer Owner ........................................................ 11. Zone or use district in which premises are situoted ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ I$. Will lot be regraded ............................ Will excess fill be removecl from pr~mises: ( ) ¥~ {~No Nome of Owner of -remises ~'~ /~/¢/-C:;'-/~ ..A~, ~..~?',~ /~.!) -- 14. ~ ~ .................. ~.:.../. ................... aaress ...~.~.: .............. ~. ...... t,none r,i0 ....................... Nome of Architect ................... : ......................................... Address ............... ~ ............... Phone No ....................... Na e of Co tractor Address Pho PLOT DIAGRAM I~--~ ~'~ --- -.~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / X ' ...... ~.L.. ~(..~. ~... ~...~.~ ~ ............ ................. being (Na~e of i~ividual signing contmc~ duly sworn, deposes and says that he is the applicam above named. /~.. He is the ....................................... ~.......~'../. .....~.....-~...: ...................................... i .......................................................... (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 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. Swam to befg~/jCe this ry '~..~ .. .. ty ............................. (Sig n~r~'~"t'f""'' ............................ JUDITH T. NbIely Public, State of New Yor~ No. ~2-0344963 Suffolk Cou~.