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Home My WebLink About14174-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16850 Date May 6, 1988 THIS CERTIFIES that the building . .A.c..c .e.s.s. q .r y .................................... Location of Property 1025 Pvt. Rd. #4 Munn Lane Orient - h3&; ~io: ....................... 's't/e~i ....................... County Tax Map No. 1000 Section ....0. I.Y. ..... Block 02 ..... Lot 0 15.004 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 18, 1985 pnrsuant to which Building Permit No. . .1.4.1. 7 .4 Z. dated . .J.u. 1..y..3.0. ,...1.9.8. 5. ............ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... .A.c.c.e. ~ p 9.r.y. cabana. The certificate is issued to NAI~CY P. KARDWELL [owner, of the aforesaid building. Suffolk County Department of Health Approval ...... ~ [ .A ................................. UNDERWRITERS CERTIFICATE NO.. N 8 5 6 2 9 3 3 / I ? / 8 8 May 5, 1988 Edward H. King CERTIFICATION DATED: B.P. #12432Z PLUMBERS Replaces Building Inspector Rev. 1/81 I~OB~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14174 Permission is hereby granted to: ...... ~. .~.~..~.~ .............. .~..~/~ ...... ...... ~.../..~.......7..Z..~7.. ............................ ...... ~/zx~r..~..:.}/..... ............ ~./...~? ,o ........ ~:~..~.~...~.....~...c~.~.~..~ ....... ~.~....~.~.~. .......................... ............ 7'~'~'''''''z''~'''~ 'ze''''~':'&~''''''z~'''/''~''d~~z ,~-.., _,-/,~- z;,. ..................................... ot ~rem,,~ ,o,ot~ at ....Z.~.~.~.....,...~......~:~......'.......,.:....,...:..~.~.~....:: ............ ........................... dO~,,~, ~ou~ ~a~ ~ap No. ,000 ~e~,ion .... ~/...~ ........ ,,~ ....~.~ ........ Lo, No...~../..~.:..~. ~ pursuant to application dated ........ .s~.~.~.~.Z..../-.~... ................... , 19.~.....~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall -A Southold, N.Y. 11971 · ' 765 - 1802 PPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted i =.i--=l to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters, 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic .features· 9.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessoryi$10.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~/,~ ........ 5.Updated C.O. $ 50.00 Date NewC°nstructi°n ...... Old or Pre-axisting Building ............ Vacant Land ............. Location of PropertyHou~e No.' ' ' /,~, .~l. . ,~, .....~ ~' 'r""~'~7~' ' "~¢'~' '~' '~' "~" '~'~" ~"'~" '~""<Street Owner or Owners of Property . . . ~.'~.~ ,,~"..,., .~.. , .~'...~..,,¢¢~. -~ .'¢// .......................... County Tax Map No. 1000 Section ..... /. ~. ....... Block ...~. .......... Lot.. ¢.~/.¢.~. ~. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No././;/Z'~'. ~..~·, Date of Permit ~'/.~..~/~ .'~. ,Applicant. · ... .................................. Health Dept Approval Labor Dept Approval Underwriters Approval ...... .. .. .....,......PlanningBoardApproval ........... Request for Temporary Certificate ..................... Final Certificate . ~ ................... Fee Submitted $/! ........................... Co nstru ction on above d ese ri bed building and perm~t_s all applic~e c, ode~ andL ~-"/~ regulat ions. THE NEW YORK BOARD OF FIRE UNDERWRITERS [O01375 aUn,=AU OF ELEC'TRICITY ~.'~ 85 JOHN STREET, NEW YORK, NEW YORK 100~ THIS CERTIFIES THAT o~y the electrical equipment ~ ~scrlbed below and introduced by t~ gppllcont ~med on t~ a~ve application n~mb~r in the premises of ~fo~eph Kardwell, Munn ~ue, ~ain Rd., Orient, N.Y~ i. ~h~ fo~o~;.~ ~,,~.t~o.~ ~ ~.~,n~.~ ~ /~ r~. ~ ~.d ~. s~,,~ m~ Lot FIXTURE FIXTURES RANGES COOKINGOECKS OVENS DISH WASHERS EXHAUST FANS OUt'LETS I SWII'CHES FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME~LOCK$ MULTI-OUTLET DIMMERS SYSTEMS SERVICE OISCONNECT S E OTHER APPARATUS: R V I C A, W C~ NO, OF NEUTRALS OF HI-LEG Ibis certificate COPY FOR GENERAL MANAGER must not be ofte~ed in an)' manner; return to the office of the Board if incorrect. Inspecto.rs may be ide,tified ~by their credentials. ~,o VEP^,TME,T. THiS CO,Y O~ C~,~ F C~ ~? ~ S~ ~[~EV ~ ^~ ~R ' TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner ~/~f~./ ~ (~ease pr~int ) (please prin%) I certify that the solder used contains less than 2/10 of 1% lead. in the water supply system (plumber' s signature) Sworn to before me this q~M day of Notary Public, County FIELD FOU FOU 2. ROU .lNg D I N;~ PEC$,~[ ON DATE COMMENTS D~TIO~ (~st) DATION (2nd) H FRAME & PLUMBING LATION PER N. Y. / ADDITIONAL COMMENTS: FIELD I~SFEC~ION (~st) FOUNDATION (2nd) ~ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 :. ..... .: Disapprowd alc ....................... APPLICATION FOR BUILDING PERMIT ..... INSTRUCTIONS State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ~. w..~.~.-. ............................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No.. ?. .m .~:¢ y. .P. ........... ,,~. Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~.a~....~?.,../?.Z .~..~.~?~ ./.7/..~..~: .~).~.~..P..~.,../.~.,.~.O?.... ................... : :. . . . . ................... House Num bet ,~/~,~ 5~ Street Hamlet County Tax Map No. 1000 Section ....... /. ~. ........ Block ....... ~ .........Lot .... /..~.~?. P..~. ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: '.5. a. Existing use and occupancy ,. ~ ~ ~¢ - )~ t b, Intended use and occupancy . .~.r~.~OJ.e.e[..~°...W-q.'~.'~..e~...~.Y.~X...~..r..~.4'.~!~)//'(.~../°.o:.~.~.~.4.~.~e ..... a. This application must be completely filled in by typewritei or in ink and submitted to the Building Inspector, with 3 ets 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ;atioll. 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 issued a Building Permit to the applicant. Such permit hall 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 hall 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, building code, housir,~code, an~l~egulations, and to tdmit authorized inspectors on premises and in building for necessary ins~~../.."~2~.. ~ t' ) ..... . . . .v. (Mailing address of applicant) g &k (chec wh, h apphcable): New ...... r~ ~--'~' ~'' · t~m°val .............. Domohtlon , ,2 ........... Other Work .......... · ug~ - .~ · ...... "" ~~~'-i (to b~ pa,d on fihng th,s apphcat,on) 5. : ~l~ber of dwelhng units ............. Number of d telling units on each floor ............... If garage, number of cars ... ~ ................................................................... 6. It business, commercial or mixed occupancy, specify natur~ ~d extent ff each typ~ of use ......... 7. D~ens~ons of existing structures, ff any: ~ront ~. ~]~ ~.gq ~ r Depth ~ ~ ..... ' ~ Rea: t~ & ~ r ......... Height ~pmX.. ~5~(x BO{. Number of Stories . .~W a .... D~ensi~hs of same structure ith alteratmns or additions: Front fi0 ~{~ ...... Rear ............... Depth ................... i. · · HeiSt ...................... lumber of Stories ...................... ' 8. Dimensions of entire new cons~ruction: Front ~f~[~ Rem ~/ n~*h /~/ . W_ · ........ On,q., .~ .......................... 9. Size of lot: Front ....~?.~ J ~..¢~.~.. Rear ....................... Depth ...................... 10. Date of Purchase ~r~& .~..Ze 2ff ........... ~ame of Fomeb Owne~ ~, .~ee~ad~ K 11. Zone or use district in which pkemises are situated . . ~ ~t.~ ~/o '" / .... 12. D~es proposed cons~uctmn w01ate any zoning law, ordinance ~regul~}[on: .............................. 13. W~110t be regraded ....... ./g~ ................. Will excess fill~e removed from premises: Yes 14. Nme of Owner of premises ~*cV.~ ~cd~g(( Address ~,~t77~7 ~rJc~ ,,~ ~ ~3 - ~3 -- ~ .,~ ~,~ , ~ .. ....,. ..~..~.Ph ...... ~ .............. t~me of Architect Oazl4erl ~/~ ~o~ Address gE? ~[F~fE~&/~ Phone No ~ - ~/ Nme of Contractor ~;/~ mdq,~ ~ ......... Aad~ess~tff~;. ~/~.'. ~Q.. Pho,, No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prop( property lines. Give street and block number or description according to dee interior or comer lot. STA'rE OF NEW YORK. COUNTY OF .,~.,~f5¢../,f--. ....... i ~'~ (Name of individual sigping contract) . being duly s above named. I ,3He is the.. p..o_[ ~.e..~... ......... , ................................ i (Contractor, agent, corporate o of said owner or owners, and is drily authorized to perform or have perfo: application; that all statements contained in this application are true to the work will be performed in the man~er set forth in the application filed there, Sworn to before me this ........ , 19 aox6. ... County... .~d, and, indicate all set-back dimensions from and show street names and indicate whether ,orn, deposes and says that he is the applicant 'ricer, etc.) reed the said work and to make and file this best of his knowledge and belief; and that the ?ith. (Signature of applicant) TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~ INSTRUCTIONS a. This application must be 'completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se~s of plans, accurate plot plan to scale. Fee according to schedule. oj~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. I c. The work covered by this application may not be commenced before issuance of Building Permit. I d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit sh~l 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 sh~ll have been granted by the Building Inspector. 't APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the B~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Rggulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. T~e applicant agrees to comply with all applicable laws, ordinances, building code, housi, ng~.de, ag~ regulations, and to admit authorized inspectors on premises and in building for necessa~~~ _ ~ (Signatkt, r~,t,,6f applicant, or name, if a corporation) Muffr~Lane ..... P, .O,. BO~ .7.7.5.,. Or. lentt .l~ew. Y.o. rk..1.1.95Z .... (Mailing address of applicant) Sthte whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. NCme of owner of premises ....... N..o.n.c.y.P....K.a.r.d.w.e.I.I ................................................... i (as on the tax roll or latest deed) If hpplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......................... (Mrs. Kardwell will advise when builder is chosen) Plumber's License No .... ~.!0.5.9.7.P ........... Mr.. Ed Kingt Orient Electrician's License No..//,2.4.2.-.E. ............ M..r: W. Ruland, Ruland Electric, Matfftuck Other Trade s License No ...................... Location of land on which proposed work will be done...M, qp..N. 9.. ..'. J .77.2. (S.e.c.t... !7.~..B.l.k:. 2.)..L.o.t .N. 9:. !5. :QQ4.... Private Road off Maln Rd. S.R. 25, Orient }House Number No. number Street Hamlet iCounty Tax Map No. 1000 Section ..... ~.7. ........... Block .......... 2 ....... Lot... ISo0(M- .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) [State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy Resldentla. l., o.n.ey.fa, m! [y. ................ ~ Intended use and occupancy proposed construction is for a swimming pool cabana 3. Nature of work (check which applicable): New Building . ..X ....... Ad ition .......... Alteration .......... Repair .............. Remqval .............. Demolition .... F ......... Other Work ............... ,i i ~ ~ 7'0 (Description) 4. Estimatea Cost . . .$. !3.,qO.O. :O. Ol Fee i -- l (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling" units on each floor ................ If garage, number of cars ..... '[ .................................................... ~ ' ............... 6. If business, commercial or mixed occupancy specify nature.and extent o ' each type of use . .. .............. 7. Dimensions of existing structures, ifany: Front .3?.' pl.u.s)y qg2.5/. Rear ~qr. qh..6.5.' .... Depth. ~O'. ....... · .2? 3.O.' i Tw.o. Hezght app.r.o,x~ .~ ... Number of Stories ....................... ; .............................. DimenSion~ of same structure with alterations or additions: Front .r)q .q! [~r.¢lqr~s, .... Rear ............... Depth I Height ........... N' ~mber of Stories ............ .... 2 ' 5' 8' I-[eight . .1.6.' ........... ~Number of Stories .F,..r... ......... 9.n.e.s. tg.r/. ................................. 9. ' ' over ,~ acres S~ze of lot. Front ........... , ........... Rear ....................... Depth ..................... 10. Date of Purchase . .M. 9.re.h. .2.,. ].9.7.4 ............... Name of Former 3wner ./¢.rs.,..O. qr.t.ru.d.e..V.: .1¢9Y9r. ...... Il. Zone or use district in which pr~mises are situated .... p.ro. p ~ r.t y. Cf qs.s. 2. 12, Does proposed construction violate any zoning law, ordinance or regulati, 13. Wdl lot be regraded ...¥9~...i ................... W~I1 excess fill b 14. Name of Owner of premises Nq'rlqy..R,. Ko.r.dw.e. lJ... Address .P~ .O,. I~ · . , . Name of Archxtect Bu ~J dOCs.. Rl.cmn~ ng.As~o.~ ....... Address ~9~g Name of Contractor .... , ..... i.. ................ Address ........ Not yet chosen - wall ad, wse. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or propose property lines· Give street and blocklnumber or description according to deed interior or corner lot. i Please refer to attached photocopies. removed from premises: Yes No X .~..5.,.Or[qntPhone No..3.2.3z2.4.8.3. ...... r?~[~ Cir~h.et IXl, y ,' Phone, No..58~.-585.1 ...... ......... Phone No .............. and, indicate all set-back dimensions from and show street names and indicate whether ned the said worl~ and to make and file this best of his knowledge and belief; and that the ith. of said owner or owners, and is dully authorized to perform or have peffox application:; that all statements coniained in this application are true to the work will be performed in the manner set forth in the application filed therev Sworn to before me this ...... .2.7th .............. day o,'f... ]¢9Y, ............. ,198..3: Notary Public ....... B.r.o.n .x ..... i ................. County Qbalified in B. ronx County CommJssJon Expires March 30,,1 1984 STAT£ OF; NEW YORK. ~, ~ COUNTY OF Suffolk i~,~ ............ l~qn. qy. ps. I~.~.rd..w.e]j ..................... being duly s~ ~ru, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...... o.'qoor. ........... I ..................................................................... (Contractor, agent, corporate of ?icer, etc.) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 xammed'( '/ / V , · ............. 19dh Approved . ? .... (Y .... Disapproved a/c (Z'i (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. . ,v Date May 27, 19 .8.3 a. This application must be 'completely filled in by typewriter or in ink and submitted to the Building Inspector, with 2 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 street~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. 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 issued a Building Permit to the applicant. Such permi~ 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 Occupanc) 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 thc Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo~k, and other applicable Laws, Ordinances m Regulations, for the construction of buildings, additions or alterations, or for removal or dem~qlifion, as herein described The applican.t agrees to comply with all applicable laws, ordinances, building code, hous~g~gq'de, a!l~ regulations, and tc admit anthonzed inspectors on premises and in building for necessa~~9~ ~ ~ (Signatpr~6f applicant, or name, if a corporation) Muffr(Lane ..... P, .O,. Box .775.,. Or. lent, .New. y.~rk..1.195Z .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general cohtmctor, electrician, plumber or builder. ......... O.w.n.e. .................................................................................. Name of owner of premises ...... .N. ?.n.cy. P.: .K.~r.d.w.e.l.I ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......................... (Mrs. Kardwell wlil advise when builder is chosen) Plumber's License No .... ~'{Q5.9.-..P ........... M..r: Ed Kin. g, Orient Electrician's License No. fl.2?.2.-.E. ............ .M?: W. Ruland, Ruland, Electric, Mattltuck" Other Trade's License No ...................... 1. Location of land on which proposed work will be done, . .~. 9P..~.o...:..].7,-?. (S.~.qt:. lY.t .B.l.k, .?). Let .N..o:. Prlvote Road off Main Rd, S. R, 25t Orlent House Number No. number Street Hamlet County Tax Map No. 1000 Section ..... 1.7. ........... Block .......... 2 ....... Lot... 15,004 .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: u ant ' R 'd ' I family a. Existing use and acc p y es~ enha , one- d b. Intended use and occupancy Propose onstruchon as for a sw~m~ ool cabana ~. Nature of work (check which applicable): New Building . .~( ....... A~ [ition .......... AlteratiOn .......... Repair ........ Remoyai ............... Demolition ............. Other Work ............... 4 Estimated Cost $.!3~,,0~,0.:.0~.! i ' ~, '.~..'~.O..~ (Description) , (to be paid on ~ing this application) 5, If dwelling, number of dwelling uifits ............... Number of dwel ing units on each floor ............ If garage, number of cars ...... ; ............................................................ 6. If business, commercial or mixed ~ccupancy, specify nature.and extent of ~ ~ch type of use ........ 7. Dimensions of existing structures, 'if any; Front .37.'.[~[Yls.WI09~5.~. Rear I~~ r.q[~ .6.5.f ...... Depth.. ~0 ...... Height oPp.rg.~f .2.5f.: .~.'. .. Number of Stories ...T.w.o. ................... : ...... ; ................. Dimensions of same.structure with/alterations or additions: Front .r)q .o. tq r. qtlq0s..,. Rear ............ Depth ...................... ~Helght ...................... Nurr ~er of Stories ................ 8. Dimensions of entire new construction: Front n~yP~[og~[l~4.. Rear..2~ ............ Depth l~ ....... Height , ].6! ........... ~lumbe~ of Stories .r./.. ......... 9.n.e.s.t.o.~. ............................ 9, ' over ~ acres', S!ze of lot, Front .~ ............ , ........ Roar ...................... Depth ................ 0, Date of Purchase , ./~9.rqh. .2~. !.9.7.4 ............... Name of Former Ow: let ,b/t.rs.,, .~.@r.t.m,d. 9 .V.: 1 Zone or use district in which premis'~s are situated Cio. ss 510 2. Does proposed construction violate 8ny zoning law, ordinance or regulation: .......................... 3, Will lot be regraded ... ¥~I..... ,~...,...........' , Will excess fill be re ~oved from premises: Yes ' 4, Name of Owner of premises Nq0c¥ .P,,, ~ ~'~i~,eJ[.,. Address P., .0,. P~ .~ 5.~.Ori. e. rl~Phone No. ,3.2.3.-.2.4.8.3. ...... Name of Architect ~4dder/", P.l~.ru ~g.As~ac,. ..... Address g , ~ Phone No. ...... .Name of Contractor , ~. .......... ,.. ~ ............. Address .......... * Phone No ................ ~of yet chosen will odwse; ' ' i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, am .indicaf~ all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and ~ how street names and indicate whether nterior or corner lot. Pleose efer to ottached.photocoples. No X ;TATE OF NEW YOgK. S.S .OUNTY OF... g.ard~veJl ........... N~n.c.y, p, ......... being duly sworn, depose . and says that he is the applicant (Name of individual signing contract) bove named. le is the ...... qv/0qr., .................... ~ ........................................................ (Co~tr~ctor, agent, corporate officer, etc.) f said owner or owners, and is duly 'authorized', to perform or have performed the said pphcation; that ail statements contained in th.is hpplication are true to the bes: of his kn ~ork will be performed in the manner set forth m 'the application filed therewith. ,worn to before me this ~?~:h ' day of 1k49¥, i 198.3.: ' Bronx "i,~ iotary Public, ........................... ALBERT ii, KUpFERMAN , ~ NOTARY PUBLIC STATE OF, NEW,~VORK'~'~ Cornm!ss~on E*,~plres Mm'ch 30, 1984 york and to make and file this )wledge and belief; and that the FO~.M NO. 2 liUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12432 Z Permission is hereby granted to: ...... .~.~ ~c.: .(........~..:.....,k~A£~,~v~.(,J,_. ....~...o.~.....i~.~...~.~..~.T. ................................ ...O...L.~.~.~T...i.....~....Y...:. ........... ~.~..g...~...-/. re .......... ~ .~ .~..~./-~..c~.......e~. C..9..~ ~...~ ~. Z7.~. :~.. ........ C~.~,.~../5..~. .............................. at premises located at I ~. - ' County Tax Map No. 1000 Section .....C~...(...~ .......... Block ....l~.~ ....... Lot No...~...(.~..-.~.... pursuant to application doted .... ~...~...~.....~. ......... "~'""7' ................. , 19...~...~ and approved by the Building Inspector. Fee $ ..~..~....7.. · .'~.0.. .... Rev. 6/30/B0