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Home My WebLink About2058-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~?..~.~.'l ...... Date .............. .~.e.p..~, .... !7..., 19.7.6. THIS CERTIFIES that the building located at . ~/8. ~9~D4~$9~ ~ 6Y9 ....... Street Map No. ,~ ......... Block No.. ~X ...... Lot No, . ~,~.., ~g}~9~4.. ~.*.~t ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... MaN'"~' ' , 19.~. p~suant to which Building Permit No.. ~er~e~ ~0~SZ dated ............. ~a~ .6 .... , 19.~., was issued, and conforms to all of the require- ments oi the applicable provisions of the law. The occupancy for which this certificate is issued is .P~i~ate..~e. family..dwo].~i~g.. ~lgh. ~ge. ....................... The certificate is issued to . .A~. Zlel$~.S.~$ ...... 0~e~ ....................... (owner, lessee or ten~t) of the a~oresaid building. Suffolk County Department of Health Approval ~I~Y...~.~...~. ~. V~ ......... u~v~w~s C~CA~I No..~. 30~.07t ..... l~g. ;3~...!97~. ............. HOUSE NUMBER .... }gaJ.~ .... Street ... ~.~. ~9~. ~Y~ ....... .~}~R~ ..... Building Inspector/ FOEI~ NO. 2 TOWN OF SOUTHOLD BU~LDIHG DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2058 Z Vote ................................... ~...~.i ........ ~.9.~... Permission is hereby granted to: &~z..t~b.~...lb,,...~.~l~r~R:./. .................................. ~.. ~.~.~..n...~,~..e~...~... ......................................... .~.o..~.~.~...V.~LI-.~,~ ...~..~.....~o.~..k ......................... to ....~.~..~.~....o.n~....f.~g~...c~.~,l~.a~ ................................................................................. at premises located at~./..~....~.-°..q..~...~....~...~.......A.?.~...~..~..~.~ ~..q'..q..fE~.~..]...~ ................................................... pursuant to application dated ............................................... ~...~.....19..~.;~.., and approved by the Building Inspector ~' Fee $10..O0...CaSh pa:l. el Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS ~_ak BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 A. Zlellnskl, Soundvlew Ave., e/o Past Mt. Beulah Rd.~ Sout hold, L.I. w,,sea,.,,it,edo,i August 26. 1976 undfoundtobei,,COmldlancewlehthereq~,irementsofthisBoard. DIMMERS Charles M. Hall, Box 417 Southold, L.I. 11971 Kuc, 657E GENI ]'his cerfifi¢o'~e must not be altered in an7 m~nner; ~elu~n ~o ~he office ot fhe Boord i~ incorrecL, Inspectors may be identified by TOWN OF SOUTHOLD BUILDING DEPARTMENT-f~- ~ TOWN CLERK'S OFFICE Disapproved o/c NOI~FY BUILDING DEPARTMENT ~ 765-2660 9AM TO 4PM ~OK REQ'h : ED iNSpSCT~ONS: UN~ APPLICATION FOR BUILDING PERMIT 1. ~SFORE BACKFILLING F~ , TION OR s~AK~ FRAMING 2. BE~O~ COVERINGjoB COMFLeTEDPIP~LtN~ Date ...... ~.~....M .................. , 19.~ ..../~- a. ~nis aoDlicetion must be completely filled in b~ t~writer or in ink 0nd submitted in triplic.te to the Building Inspe~or, wit 3 s~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to ,djoining premiss or public streets or areas, and giving a detailed description of la, out of pro~rW ~fl~ pe drawn on diagram which is part of this application. o. The work covered by this application ma~ not be commen~d ~fore issuan~ of Building Permit. ~ d. U~n approval of this application, the Building Ins~ctor will issue a Building Permit to the applicant. Such ~rmit shall be kept on~' the premis~ availabl~ for insertion throughout the work. ~ e. No building shall ~ o~cupied or used in whole or in part for any purpos~ what.vet until a O.~ifi~t~ of Oceupano~ shall haw ~o~ gront~ b~ the Building Ins~ctor. 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 o~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law~s.~ ordinances, buildings, ode, housing (:ode, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectiOns. , j (~ignature of apl~cant, or name, if a corporation) ' . ~ddress of applicant) J J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. · · .............................................................................................. Name of owner of premises ..~LI~.~..~a~....~.~..~.~L.~.~..~, .......................................................................................... 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.: ....:....7.~.~....~..~.....~tL~ ................ Lot No ............. Street and Number ........ ~[B~.~...~....~..~-L..~LG.~I..~A.~.~U.~.t.~a~-- ................... i ............ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: e. Existing use and occupancy ..... .~..~..~, ................................................................................................................. use and occupancy .... .................................................................... b. Intended 3. Nature of work (check which applicable): New Building ....CH....~...~ ...... Addition ........ ~ ........AIteration.......'~... ..... Repair '"' Removal ~- Demolition ~ Other Work .................... ' ................ 4. Estimated Cost ...~.....~.~.~ .......................... Fee ? O ~ (Description) {to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ............. ..~t ........................ If garage, number of cars .............. ~-n .......................................................................................................................... 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 ......~..3...~.~..'~, .......... Depth ......~r..~...~.~/. ................ .......................................................... · e, ve, Height ~ ~r' . Number of Stories ......~ .........~. .......................................................... Dimensions of same structure with alterations or additions: Front ........... .--'". ......... Rear ......................................... ~ igh Depth ............................................. He t .............. ~ ..................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .....~.~..~...e. ....... Rear ....~..?~...~..~...*~ .......... Depth ..... .'~../. ................... Hei ht ~.~ ~r Number of Stories ~/,~.2" /C4.a~- 9. Size of lot: Front .......... /.~.~..~....~... .......... Rear ......... /.~1..6...~ ................ Depth .....~..~.~....~...~.. .......................... 10. Date of Purchase ..... .~..'.~/~..-..(e.~[ ........... Name of Former Owner ..... ~.~.[a..~...fl..~. .................................................. 11. Zone or use district in which premises are situated ....... ~&a.4z~.J,.e~. ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..~.~..~..'~.. ......................................... 13. Will lot be regraded ..~. ...................... Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises &~(.J~s~`~.~.~L)~L~.~¥~%~.~~!~r~~ ..... __ (Address) J I (Phone r~o.i Name of Architect ...~..~.~[~..~.~..~V....~.....~.~.~.l,~...'~:~...;~.....~..~..~.~3...~l.b~..[~...~ ............... .... (Addres~)~. (1~h_one ~o4 Name of Contractor ~..~.~.~(~:~'d..~.b.~.~L~/.9~vee~w.&.~....~1L~-~...~.~3+~.~.~=~.~.~.~ ................ (Address) ~ / (Phone No.) PLOT DIAGRAM Eocate 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. (---7 STATE OF NEW YOR~/~ )SS COUNTY OF .....~/~,~.~ ................... ) /ao /=7" ...,~(~,...~-..~...~..,..[,x.,.'~i..~.~....'~,.~....'~..J. ................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individ~l si~ing con~act) He is the ...~.~.~...~..,.~ f..~.~ ......................................................................................................................................................... {Co~t~ctor, a~nt, co.orate officer, etc.) of said owner or owners, and is duly authoriz*d to ~rform or hav~ parroted th* said work and to maka and ilia thi~ a~Olieation; that all statemants contained in this application are true to the beat of hi~ kn~O~af; and that the work will ~ ~ormad in th~ ~nnor ~t forth in the ~p~lication filad tharawith. ~o~ ~u~li~. s~o~ o~ N~w York / ~ ~A~ ~ ~. ~No_52~344963 SuffoJk Coun~ ............... ........ ......... ............. 30,1 ............................................... ~ I ~mre o[ applic~tl TOWN OF SOUTHOLD .... ~ -., J .~. ~ ~ TOWN CLERK'S OFFICE I'v'*'~'/~ ~ ~'~ '~ '~' ~-/~ SOUTHOLD, N. Y. Examined ........ /.'...'{ ........ ~.. ...... 19 ..... .~ Approved ................... ~..'. ................. 19....:...Permit No....~........~....~...~.~...~.~.. (Building Inspector/ 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 be drawn on the diagram which is port 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 o 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 Occuponcg'-- 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 T~wn of Southold, Suffolk County, New York, and oth~r'~p~licable Laws, Ordinances or Regulations, for the construction of buildings, adc[itions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ......... ......... ·/..~...8 .~..~.~. ~u...&~. ~ ~..u. ~. [.~0.9.u~.T. ~ ....~....~a.~..~ ..... (Address of applicant) State whether applicant is owner, lessee, agent, archit, ect, engineer, general contractor, electrician, plumber or builder. ........... ~..~...~..e....~......~.~.~..~ ~..e...~4~ e..o..~.T.~,~gT.~.~.... ................................. i ......................................................... Nome of owner of premises....t~'.~..-~....~..9..i~..L.:..'~(.~...L..~.~¥~,~. ........................................................................................... 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 ....~ .~.....~,...0....~..)...~....~..........~..~..~.~..U...~'...,......-~..O.~r.~.g~./.~,. ................................. ~1- /~ ,,~/._~' Mufiicipality ....................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..~..~...~...~..~.~.....~..~....~..~.....~....~...~hT..~.~..~..T.~.~....~.~.~.~ ....................................... b. Intended use and occupancy~...~...~.~.~...~..~.~.~:......~D.~-.~....^....~"~...~`~.~..~..~..~dm~.~x~1.~.~.~..~..~.~.~..~D.[~.~ ..... 3. Nature of work (check which applicable): New Buildings... ddition .................... Alteratio ............... ~... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost~,,~.~,..~.~./.~'~..~.,...../'~....J...~',.~.~..~.'..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.~.....~.~ .................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 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 ................................ 8. Dimensions of entire new construction: Front....~].¢.~.f ........... Rear ...~.l..~ .......... Depth ..~.~.~.~(. ............ Height ....~[ ................ Number of Stories ....... ~ ........... 9. Size of lot: Front ....J~.~[ ............... Rear ...... ~.~..f. ............ Depth ....~.~.~.l. ............. 10. Date of Purchase .~.~.~.~.~.y.~.~.[ ....................... Name of Former Owner ~.~.~..~.~.,.~ 11. Zone or use district in which premises are situated....~.~.~..(~...~.~.~].~ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ~.~.~ .................................. . . . . . ~ ~A~- 13. Nome of Owner of premises..~.~.~.~.~Address .J~.~e~..~.~..Phone NO,~.~.~. Nome of Architect.~.~&~.~.H~..%.~,~T.~.Address ~.t~.~.~..t.~*~*..Phone NO ..................... Name of Contractor...~.~..~.~.~.~ ............. Address ............................................ Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali 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 yOR, l~, ~// ) S S . ....~...~,.:~~''~ ~ ........................................... being duly sworn, deposes and says that h~ is the applicant ] (Nome ~indivi~al signing application) above named. He is the O~ ~ ~ ~ONT~O ~ ....................... (Contractor, agent, corporate officer, etc.) of said owner or owners, end 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 ~st of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. ~ Sworn to befor, me this __ JUD,T, '. ~OK~ ~...~. ~. ' '~ ~a~ Public, State of New Yor~n~ ............... ~ da~ of ................. ~ ..... 19.,...~44,~. Suflom co,,~:~ ...... of ~licant~~ ~ ~/ ~ ~[/ J ~~piles Marc~ ~, Z~~ ~ Not~ Public,~~.r..~ ........... ~.C6ffn~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19 ........ Approved ....................................... , 19 ........ Pemit No..,~,..~...~'...~....~. ................ Disapproved a/c ............................................................................................ Application No ................................. BY ............................................................. ,',~.:iFY BUILCING DE ¢~]Mc,~ A1 (Building Inspector) , .-2660 9AM 10 4PM FO~ ' ~ NSFECTIONS: ["L ~APPLICATION FOR BUILDING PERMIT ~ OKh BACKFILLING ~ - z:,c ~_ C~V~R1NG WIP,.Lff~ Dmte .......................... , ]~ ...... ~L WHeN JOB COM~'LL a. This ap~Hcation must Be com~letelg filled in bg t~oewriter or in ink and submitted in triplicate to the Buildin~ Inspector, with 3 s~ts of ~lans, accurato ~lot ~an to ~cale. Fee accordin~ to schedule. b. Plot ~lan ~howin~ location of lot and of buildinfls on premises, relationship to adloinin~ oromi~e~ or public ~tr~ots or area~, and Oi~in~ a detailod description of layout of ~ropertg must be drawn on diagram which is part of t~is a~lication. c. Th~ work co~ered by this a~plication mag not be commencod before issuance of ~uildin~ ~rmit. d. ~on ~roval of this a~plication, the Buildin~ Inspector ~ill issue a BuHdin~ ~ermit to the a~Hcant. Such ~ermit ~hall be k~t on e. ~o Buildin~ shall Be occupied or used in whole or in oart for ang purpose what~ver until a Certificate of Oecu~ancg shall havo been ~rante~ b~ the Buildin~ 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, housing code, and regulations, and to admit authorized inspectors on premises and in buitdings for necessary inspections. of a~,~.~,,~. ,~, ,..,.m. if a corporation) (Address°f applicant) / / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ..A. ..................................................................................................... Name of owner of premises ..... ..~...~..'~4.¥...L,...~.~..~,.~...~.X .......................................................................................... 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 ............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~L~..~..~. ............................................................................................................. b. Intended use and occupancy ...... .~.,/~..~..~..~.....~..~....~s,~,,~.~.~.~.~.~..~ ..................................................................... 3. Nature of work (check which applicable): New Building ....(~1..,.~...) ....... Addition ............... '-". ..... AIteration......'~... ...... Repair ......... ..'~.,......: ..... Removal ....... ~ ............. Demolitioq .......~ ............ Other Work ........;._....'~...:.........; .......... ~. _ i0 u,,~ c, ~uescnp[ionl 4. Estimated Cost .....?.~i~.~ ............................. 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 .....~.I~.~..%.~..%. .......... I-- II · 7. Dimensions of existing structures, if any: Front ....i~.~...~. ..... Rear ....... ~.~..~..~.~. ....... Depth ....~...~. .................... Height ......... ~/.~.../. ......................................... Number of Stories..,...C~. ,..l~....~...~ ...................................................... . Dimensions of same structure with alterations or additions: Front..........................~ Rear ......................................... Depth .................... ..--T... .................... Height ................. '~. ....................... Number of Stories ...........~ ...................... 8. Dimensions of entire new construction: Front ..... ..~,~.~.fe...*. ...... Rear ....... ./'/.~..~. ........... Depth ....~..~./. ..................... Eel ht J~.' Number of Stor es /...J~... ~ ,~,'~J 9. Size of lot: Front ....... ~/~...~....F...r~... .............. Rear ....... /.a...b...F.....[~.. ................... Depth ........ ;~ .~..b.....~...~... ....................... 10. Date of Purchase ..... ~...-J~.-,.~..~-a ............. Name of Former Owner ...~-~..~W..q.,~. ..................................................... 11. Zone or use district in which premises are situated ....~.~,.Jq~L~..[~,.'.~/..~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~J.~.~..~. ........................................ 13. Will lot be regraded ........ ~.~. .................... Will excess fill be removed from premises: [ ] Yes [k]"l~o 14. N a me o f Own er of p re micas ~./l.~,~'..I-..~,,~.%~..~ )[~.~ .C~t..~'.. Z.~..~I....~. ~-.~ )~....~;Lg.~J~.$..-1.s J~ ;~"...~.,~''''~ ..... (Address)~ J j{Phone No.) Name of Architect .~1~.~,~.[.~.~.-,~..~.~..~...~....~..~l[i.~f~.-~'~.~.~,.,~-~..~..,~t--~.~.~.~[~;: ............... ~ ~ tAopress) ~ __ &o'none.. ~o.~ Name of Contractor ~[~.~Jf~%~j~-~-{~}~!~L~?Lq~.~..~.~~-`.~ ......... .,~IL,~.,-/'....~.-~ ............. ~Ai:ldressl J / o'none mo.1 PLOT DIAGRAM I,ocate 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. STATE OF NEW YOuR _1~. ~/'/. ~ . ) COUNTY OF .........~j/~'/k~ .......... ) SS ..... ~][~..~..~t~l~/~.....~:....'~...~..!..l..~..~...~..J ............................................... being duly sworn, depo,s and says that he is the applicant above named. (Name o~ individ~l si~ing con~act) He is the ....~.~.~....~...~I.~.~ ........................................................................................................................................................... ( Cont~ctor, a~nt, co.orate officer, etc.} of said owner or owners, and is duly authoriz*d to ~rform or have ~rformed the said work and to make and file this a~olication; that all statements contained in this application are true to the best of his k~9~fi~_~elief and that the work will be performed in the manner set forth in the application filed therewith. Not¢~, Public, $1afe of New York ................. ~...~......dey(/~ ..~,'~'. ~°'..... 2~..~. ~/~.~...~.~.~/~-'~/~ ~/~.lg ~ ............... ~x..p.!r.e S~March ,30. J~/-~"'~ ~--;~l'~l'~ ;) ..................................... Notary Publ~Z~zff,~,~,Y~..,~......,,dJ-Z....~....-~.~c~.,~..... County ... NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined .................... ! 9 ........ ', 2-0 Approved ........................................ 19 ........ Permit No .............................. Application No ~ O ~" ~ Disapproved a/c ........................................................... 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 a detailed description of layout of property must be drawn on the diagram which is port 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 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 a Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with afl applicable laws, ordinances and regulations. (S~nature of appli~.)nt, or name, if a corporation) .I..~...~.~.~ m ~,nL .~. ~.~ ~ .~.~.¥k~.~. ~.T...N~,I,.e..~, ..~X. ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... .0.~.~.~.~ ... ~,..~..~....~.~..~...~,...~.~T. ~.~.R,. ....................................................................................... Name of owner of premises.......~..~...~....~k~...~.:..~.. !..~.L(.I9,~.~. ~, ............ i ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Numbe~/~......~.~..~..l~..~....~/..t.~..~..~.....~..¥..~.lb]Ll~.~;..~+.....?..c...4.(.~.~.~../~ ......................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....~.....l~...~. ~.(~..~....~.~..~J~.....C~....~..~.[~,g~..'[..l~'.~....~...i.~J~..l~. .............................................. b. Intended use and ~c~:up~ncy~~`-~.~L~-~.~-~~~!~ T'~,(~L ~o%~. 3. Nature of work (check which applicable): New Building ...... ~.....Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..J~...~t,..~..~..~..!.~.0.~.:...i~..~..~...I.~.e..q......Fee .,Z'.~..:P..9. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling unitsq.~..,~....l-~,'~..~'~-.--~l~..Number of dwelling units on each floor ............................ If garage, number of cars...~.~..')......'l'...~...~. ..................................................................................................................... 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 ................................ 8. Dimensions of entire new construction: ............. Rear ..... ..~.~'.l....~..? ......... Depth .~/.~.../.~.././. ............. Height .....J..~.!. ............... Number of Stories ...... ..'ZT. .................. 9. Size of lot: Front .... ~.~.0..!. .............. Rear ..../..0..0.../. ............. Depth ...~..~'..~.! ............... 10. Date of Purchase .~..~.J~.~Q~.IJ.(~!. .............................. Name of Former Owner~i.0.~..~J~fi-.l~l~i~l...-/k~.O.~.*~'..~--.~-....~.. 11. Zone or use district in which premises are situated.....Y~...O..k'~..(.~~l-..~l~.~...~..~.l~.~.-~.-~.-I~J~ ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~..~..~.~. ..................................... 13. Name of Owner of premises../~.T.J~gl~.I~''/~-~.Addressj'~.l~'i~'~'''~'~/~'N'~ ...... Phone NO.O.g.~.'.~,.~.'.~..~' Name of Architect/~.~,J'JJ-/~,~..~.N.~l~.~..~.~"~"~"~'~'"'Address '~'"~'N~I~"'~'"~'~'t~'':''''Ph°ne NO ..................... Name of Contractor...S'....l~'.),~....J~.~!.'~'~.R ............. 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 [ot. ~I~W ~ ............................................. being duly sworn, deposes and says that he is the applicant ndividual signing application) ab~ove named. He is he 6N~I...I~.~ .~. .~....~....1~..~...1~..~:..~...~.~.~ ................................................... : ........................................ .................... (Contractor, agent, corporate off car, 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 ~st of his knowledge and belief; and that the work will be performed in the ~nner set forth in the ap~cati~n file~ there~ith~ Sworn to befor~ me this ~~. ~..0.=~.. · , JUDITH T, 80~f~ ' ~ day of ....... ~ ......... 19.~,~t~ ~t~te o~ ~ature~~) .............. ~ ........ ~~~ ~ ,~ - 983 ~r~s Suf~ olk~ew Coun~ ~o~ / - ~