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Home My WebLink About1755-zFOP~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I~I~I~TIF'II~AT£ rIF rII~I~UPANI~¥ No.Z .~.~j~ ..... Date .............. ~e~R. · ..~. ·., 19~. THIS CERTIFIES that the building located at -E~. ~2ea~-A~e ......... Street Map No..~ ........ Block No..~ ....... Lot No. '~"~O~' ~8~'d .......... co.ores substantially ~o the Applieati, on for Building Permit heretofore fil~ in this office dated .......... ~p~l~...~ .... 19~. pursuant to whi~ Building Pemit No..~[~.g dated ............. ~.. ~ .... 1~6~., was issued, and conforms to all of the require- me.n~ ,of the applicable provisions of the law. The occupancy ~or which this ce~ifieate is issued is . ~a~ '0~ ' ~11,~'~' ~T~g .......................................... The ce~ificate is issued t,o ... ~°~'D~F'.~....~er, lessee tenant) or of the ~or~aid building. Suffolk County Department of Health Approval ...... ~ ........................... ..... ( ( Building Inspector FOH/~ ~0. :~ TOWN OF $OUTHOLD 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) N.o 1755 Z Permission is hereby granted to: Date .......................... ~ ....... ,g& ........ 19~... ~}~n. · De 3..n ne.-.-.-v ............................................ ....... ~'~.se~u .A,~re ................................... to. B~'t~..~_~' ~td~i~,-~,o~,-o'~-,,a.w_-'e~:t~;~LzLg' d~e'l~i~ ................................................... at prennls&s located at ...~/~... ']~O~'~e~'l~"~L~'l~ ........................................................................ ............. ~ ...................... Sou~haZd.i. ..... ~.;.~ ............................................................................. pursuant to apphcat~on dated ............................... JJJ~ '~l~'" ~ ..... 196~,..., and approved by the Building !nspector Fee $'-"~;;O0 .......... FOR, M NO. 1 TOWN OF SOUTHOLD BULiLDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...........~.% a ¢ ~ ~'- .......... ,19 ........ Approved ................................ ~..~....., 19... ?....Permit No. ~.(. ~...?....Z .... Disapproved a/c~ .............. (Building/Inspector) Application N o. ~..~......~'....'~.. ........... 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must bedrawn on thediagram 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt 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. (Signature of applicant, or name,'i~ a corporation) ................... ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ....... ~°..~z'ff~....~.*.....g~...]'..~.~..e~'.. ............................................................................................................... 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 ...............~.o.~.s..s..e.~....A:~'.e.~,a~., ........................... ~.~.~.o.~..!~.:...~..: ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ...~,.,e.~:~..~.~ ...................................................................................................... b. Intended use and occupancy D,,4e~_~ng al'~cl ~tcl. cl~.%~on 3. Nature of work (check which applicable): New Building .................. Addition ....... Z. ......... Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ / 5" o - .... 4. Estimated Cost ....... ,. ................................................... tee .......................................................................... (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.....~).t....8..". .......... Rear .......................... Depth ........... ~.8.!....8..". ....... Height ............................ Number of Stories ...........~ .............................................................................................. Dimensions of same structure with alterations or additions: Front ........ .s.~ ................ Rear ................................ Depth .......s.~.lae. .............. Height ................................ Number of Stories :settle 8. Dimensions of entire new construction: Front ...... ?~1~...~..~ ............ Rear ............................ Depth ....~3..8.!....8.'.~ ............ Height ............................ Number of Stories .......... ~ ..................... 9. Size of lot: Front ...... .]:.0..0..I. .................. Rear ..~.! .................. Depth 10. Date of Purchase ........................................................ Name of Former Owner ...... .~.:~..~...s..t....~....a~...e..z: ......................... A-Res. 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 ...J'..o..~..~...~.:..D..e..l=..a..~..Z ....... Address ....... .B..o.~.s..s..e.~.~.y.e.... ........... Phone No.S..0.~.'.~.0.~ ..... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YJ~RI~,/ . j ) ,, ,. COUNTY OF ..~..) ~'~' ................ ~~:~) (~,~ ~/r),~.~ ...............................be'rig du y sworn, deposes and says that he is the applicant (f,~ame of' individual sig~i~'gapplication) 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 all sta¢ements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the rj~rt~ef. ~tKk-fl~rth in the application filed therewith. Swo to before me this Notery Public, State of New York .......... C~Z~....=. day of ...................... ,~. i., ~ ~ ':k- /d/~,L~ ~ Notary Public .,_..~...:.~~ (~'f~'"i~'i~l~'ature of applicant)