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Home My WebLink About2529-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMF. NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P.E~TIF'II-:ATE ElF E] P, I-: U PA N P, Y No. Z 2897 Date O~:Obe~c 20 19 67 THIS CERTIFIES that the building located at , ti~i].ey Ava. & ~lln Street Map No. ~ Block No. ~ Lot No. ~ G~een~,.~. ~... conforms substantially to the Application for Building Permit heretofore filed in this office dated Octobe~ 4 , 19 6~ pursuant to which Building Perm[/No. 2529 .Z dated 8e~= 29 , 19 54 , was msued, and conforms to all of the require- ments of the applicable prowsions of the law. The occupancy for which this certificate is issued is addt~iqn. ~. gP~. ~%Y. ~9%~ ............................. The certificate is issued ~o ~~ ~.~.~Y ............................... (owner, lessee or ~enan[) of fhe aforesmd building. Suffolk County Department of Health Approval ~ ..................... Building Inspector FOg, M ~o. 2 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? 2529 Z Permission is hereby granted to: ,. A~t~ ~,~r...W~4~ m~jr ....................................... ......... ~l~..~.,~¢e .................................. to ..l~lt6..e~..e~l~..~lo~..o~...m~..e~!~..~l~re~ ........................................................ ............ ¢~r~r.~__~e...gr~m~e,l..1~y.. ~/.App~.:~,~ ) ......................................................................... at prem,ses located at ...... ]~l~'l_e~ ~.~l~ ~:..~igll~i~.~..~X~t)~ ....................... .................................................... ~ez~t~o~.l~ ..... ~,,:Z. ....................................................................... pursuant to application dated ......................... .O~.t431~e~......~ .......... , 19.~.., and approved by the Building Inspector Fee $..~'.,,0t~ ............ Building Inspector FOI~M NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved ................................ ' '~'"~"- (Buffd mg In ' APPLICATION FOR BUILDING PERMIT Date ................. .0.~ ~.0.]~.¢~. ....... ~ ............ , 19.6~ .......... 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 bedrawn on thediagram which is port 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 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 po 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. Anthony J. Wisew.a...t.~. ................................ ~7 "' ~ ;,4 i (Address of app,icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premisesL......]~.~c.~.~J:.~:~:~:~3sO~g..sl[,i ......................... . ......... 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: ......Z~...~ ...... Street and Number ....~il~._A~.e...&..Oha~l~±&zz..~¢.er....O.~.a~n.F.o~t ................................... Mun c pa ~ty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....D..~...e.~.]~.~.q~ ............................................................................................................ b. Intended use and occupancy ............ ~.~. ......... .V..J,.~.]?,...~Zl...~.qt,~!J,~J,.ct~ .................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ...... ~X~. Alteration ....... .~.:..~.¢ Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..~.~.0.C~O...~./,~ .................................... Fee ...~...,.~ ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........o.b.e. ............. 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 .~e~.±~.e.~,e ......... 7. Dimensions of existing structures, if any: Front....21.-..~ ............. Rear ...... ~..r~ .......... Depth ...... ~.~..-.~...i .......... Height ............................ Number of Stories ...... q~ ................................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....... 2~'. ................... Rear .....~..~. .................. Depth .......... ~.?. ............. Height ............................ Number of Stories .........o..~..e. .................... 9. Size of lot: Front ........ .~.~ ................... Rear ........ ~'. ............... Depth ......... .~...0. .......................... 10. Date of Purchase .............. ~.c)..~ ................................. Name of Former Owner ...... ..~.......~..C..o.~.o..9..~.~..J: .................. 11. Zone or use district in which premises are situated ......... !!~.!!...~,.$..~ ..................................................................... 12. Does proposed construction violate any zoninn law ordinance or reaulationP ~es 13. Name of Owner of prem,ses ...~.....~,Z~q~.o.~..~.'ff~.~.....'Address'"'"~. ...... ..... Phone No Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....A..:...~.:...],!~.~..o.~.~.?,..,?. ............... Address .......... .g.?..~.~r!..O.~ ............. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 YqRK, ) COUNTY OF ...~.~.~..~.Q]~T~ ........) S.S. ? ....................... .~....~o...;~i.~Q~.ft.~,~. ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... 2.~..~.~.~.$.~.e.?.....~.Z...~.o.~?...~.~.~ .................................................................. i ............................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to oerform or have performed the said work and to make and file this application; that all statements contg~l~ in~.i.~ a~j;dication are true to the best of his knowledge and belief; and that the work will be performed~jf~ryt~Jim~l~_~[~0~'~t_ h in the application filed therewith. Sworn to before me this ~m ~sson ~.- o--~'lobSii°34~c~ ~0, ........... .~... day of ................... .~¢..~ ~i~. e Z' , 1963 ,'~ · ' ...................... . ................ :.... .. Notary Public, .....~~..k.~..:.~~ ~~Si~ure of applican~ .................