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Home My WebLink About1938-zFORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. r:EETIFIEATE OF or.r. UPANr.¥ NoZ. 2999 ..... Date ............... Nar~h...8 ....... 1968. THIS CISRTIFIES that the building located at , .E/~.. ~O~.~1,,. [ll';~,?,e ........ Street map No.~.hor. e. Acrem]oek No ............. Lot ~o. ~1 ~. · .~Iatt£%uCk~. I~,¥., ......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ........ Bepi; .... 20 ..... 19~2.. pursuant to which Building Permit No..:1~3~. ~ dated ......... .I~ov~.. '~3 ...... 19.6~., 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~0ivat;e..o~e · fami.l.y, dwet.Sing .............. ........................... The certificate is issued t,o Ittlgl~ .&. }4al'.lh~ .Iu~'t~¢l~; ...... \ .....0%'trl,ez'~ ............. [owner, lessee or ~enant) of the aforesaid building. .Suffolk County Department of Health Appr.oval .. ~',~.~ ................................. 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) N? 1,938, z Permission is hereby granted to: ........ ....... .~~~ .......... .~_~.~.......~ ~;~...~ ........ · . ~~...~ .......... ~..~..~...~ ........................................................... ...................... : ........... ~....::~;..~ ................. ~::~.~...~......I ........................................................... ~, ~,~i,~, ,o~,~, ....~_~:~..~_.: ................... ~-:::~.....~.~ ............................ ............................. ~ ..................................... ~"'~~;'~,Z~ ................................. ................................................................ ~'"'"D';; ............ Z~ ............. ~ ................ pursuant to application dated ............... ~~ .................. 19...~.., and approved by the Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Approved ........................................ 19 ........ Permit No ............................... APPLICATION FOR BUILDING PERMIT Date......~.. ¢~../3. ......... ..'~A..~....IT ................... 19.~.~ ..... IN'STRUCTIONS a. This application must be completely filled, in by typewriter or in ink and su~mi~tted 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 a detailed description of Iayout of property must be drawn on the diagram which is part of this location. 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 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 issuanoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (S gnature~f applicant, or n~me, it a corporation) (Address)'of applicant) . State whether applicant is owr~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. .............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ...~./...~J~;~.£.....~.¢..)~.~.,,S... Lot No: .~..~4.~..~.... Street and Number ......... .-~..~..~.:/~,..A......O....'/%L ./~..¢¢ ................ /~']..~...~..i~,./.'~..~..¢_.¢.¢(~. ......................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy .................. ~...¢,...~'...L..~...¢.....~...~....~.. ......................................................................... b. Intended use and occupancy .............. /.~....~-....4~...( .¢~..£...~...~....'¢L~.. ..................................................................... property lines. Give street and block numbers or description according to deed, whelher interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ........ Alteration ' Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost....~..~,.,.0~O. ~ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......~..~.~r. ............. 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 ...~..8!..O.?,,~. I Height ....)..~. ................... Number of Stories ........... .O...~.'t..~.: .................................................................................... Dimensions of eame structure with alterations or additions: Front ...... ¢'/'.~'7..'...~../..I. ......Rear ..... .~..,,,4~'....~.' .............. Depth ...,,~.~....O.,%, ......... Height ....... /..~. ................. Number of Stories ..... ~...~..~,r:. ........... 8. Dimensions of entire new construction: Front ......... .~...~ .......... Rear ..... ~.....~. ............. Depth ..~.~...O...~ ......... Height .....)../~....~ ............... Number of Stories ...~..l&~. .............. 9. Size of lot: Front ...ZI.O..~..I.I ............ Rear ...I..~.~.0..,~'.~'7 ...... Depth ...~.e~.~.'~.h../~l..~.~- ~ &eT 1, ~' 10. Date of Purchase .~..~,.~..~../.~.)..La/../a.~,~ ................ Name of Former Owner ....... .......... 11. Zone or use district in which premises are situated ................. .~...~--.~'...z..~...¢...~q,..~'~...~-~..~ ................................... 121 Does proposed construction violate any zoning law, ordinance or regulation? .......... ..~...~ .................................. 13. Name of Owner of premises.../~/e.~c¢/../1...~.~,.)/.m~'..{1. Address ...'S.e~.~.~.4..~.~..~v..c~z~.~.....Phone NO.~.~.~.~..z'/:.! Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ....... ....... Address ~.~.~.'/~.~.,~;,Iz.~;,~J~'~r,//;4a4'~hone PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate Plo t 0 S'rATE OF NEW YORK, ) S S. COUNTY OF ............................ ......................................................................... i ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................................................ i.~.~.~¥.r~[.~..~'~'~:'~'1~'c~"~¥i~[.7'~'~ii ........................................ 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 fort~ in the application filed therewith. Sworn to before me this ........................ day of ........................................ 19 ............ (Signature of applicant) Notary Public, . ........................................................... County ' y'~D~¢ ~