HomeMy WebLinkAbout3257-z~OR1V~ 1~0o 4
TOWN OF SOD~HOLD
BUILDING D£PARTM~--NT
'~'OWN CL~-RK'S OFFIC~-
SOUTHOLD, N, Y.
EII~I~TII~IEIATI~ OI~ or!.cIUPANI~¥
No..~..3.0.Q3 .... Date .............. .~O?.?.h...?~. .... , 19..6.8.
THIS CERTIFIES that the building located at ?../.~...0.a.k..1.a..~...A.~.e...E..X~.?.l~?.i.O~reet
Map No....~:~.. ...... Block No..~ ....... Lot No....~g;~.....S.O]l.t.h.~fl..~..~:.~.~. .........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated Oct ~0 19.6'.~. pursuant to which Building Permit No. ~.~.~7. ~.
dated ....... .0.~]; ...... l0 ....... 19.~5., was issued, and conforms to all of the require-
merits of the applicable provisions of the la w. The occupancy for which this certificate is
issued is .. ~r..~?..~.e...o?...~.:~.~.~. 79.;..~ir. ~ ........................................
The ce~i~icate is issued t,o ?..o??:.r~...~.~:~..~.~. .............. ..~.-.n.~.r .....................
(owner, lessee or tenant)
of the efforesaid building.
.Suffolk County Department of Health Appr. oval. .]~.~ ~.~.. ~)y..~. Vi~ ........
FOl~1 NO, ~
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? 3257 Z
D~te .................. ~c.tohel-. ...... ~fl ........ ,
Permission is hereby granted to:
........... Jo.s e~l~ ..&..~lenda.....Radich .............
....................... 8~u%ho.14 ......................................
to .~$.1~1.. new.. one ..f~m:L. ti ..dwe.l.~in~ ..................................................................................
at premises located at ..... ]~/.~...,.O,a.k,~:Z~..,~'e..,E;~6 .......................................................................
................................................... i]out~ot~.t...., g ~.¥.. ..........................................................................
pursuan¢ to application dated ........................ O0.t~.....1',O ................ , 19.(~.., and approved by the
Building Inspector.
Fee $.~,0.0(~ ..........
I,:. ( /,...
+'"~'x~'" ~'t'"? ............. /'"'":t .....................
Buddmg Inspector /
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
n te
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure located
(Giv~ deed location)
have been inspected by this department and found to be satisfactory.
Uz.:
District Engineer
District Engineer
FOR~ NO. 1
TOW~ OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Exam,ned ....... ........
Approved ........................................ , 19 ........ Permit No ................................
D~ sap~ rave~ ...............................................
Application No ...........................
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. Th~s application must be completely filled in by typewnter or ~n ink and submitted in duplicate to the Build,n,
J nspector.
b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o
areas, and glwng a detmled description of layout of propertymust be drawn on the dtogram which is part of this application
c. The work covered by this application may not be commenced before issuance of Budding Permit.
d. Upon approval of th~s application, the Building Inspector wdl issue a Building Permit to the applicant. SucJ
permit shall be kept on the premises available for mspechon throughout the progress of the work.
e. No budding 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 Budding Department for the issuance of o Budding Permit pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein described
The apphcont agrees to comply with oll opphcoble lows, ordinances, building code and regulations.
.fl ................ : .............
'o corporation)
Southo!d ~ N.Y.
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
0.~.~.~' ..........................
Name of owner of premises .... J. os~p~..P~d.~c~ ................................................................................................................
If applicant is a corporate, signature of duly authorized officer
(Name and t~tle of corporate officer)
1. Location of land on which proposed work will be done. Map No' . ........... :~cZ,. ........................ Lot No:Z,.~ .............
Street and Number ...~/.~ ..... Oak~.w~..A~e...E~t, ............. ;~g~oTLcl. ..................................................................
'~ Mumc~pality
2. State ex~st~ng use and occupancy of premises and intended use and occupancy of proposed construction:
a Existing use and occupancy ....... ~g,~t.~..]~:t~ ...............................................................................................
b Intended use and occupancy ............... o~...~.a~.],.y..~w~.~.~ ..................................................................
3. Nature of work (check which applicable). New Budding .... ~ ..... Addihon .................. Alteration .................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ....................................
4. Est,mated Cost ..... .~.....2..0..~....0...0..0....?...~.. ........................ Fee ........... ;I..0.~.0. .................................................................
(to be pa~d on fihng th~s application)
5. If dwelhng, number of dwe}ling units ....o.b.e. .................. Number of dwelling units on each floor ..........................
If garage, number of cars ......... t~¢~ ..........................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..............................
7. D,mens~ons of ex,sting structures, if any: Front .......................... Rear .......................... Depth ..........................
Height ........................... Number of Stories .............................................................................................................
D,mens~ons of same structure with alterations or additions' Front ................................ Rear ..............................
Depth .............................. Height .............................. Number of Stories ........................................
8 D,mensions of entire new construction' Front ..... 6~ .................. Rear ....... ~ ................ Depth ..~6/f...2~ .........
Height ............................ Number of Stones ....... .1.~ ...............
9. S~ze of lot. Front .... .']-;].~,6 ........... Rear ...... ]..1.2~ .......... Depth ........ 3.2.~,2. ...........
10. Date of Purchase ............Zb.c)~.~ .................................. Name of Former Owner ........ .n2~:~~ ....................................
11. Zone or use district m which premises are situated ........ ~J.~.tt ................................................................................
12 Does proposed construction violate any zoning law, ordinance or regulation? .......... .~O .....................................
.k'l. .
13. Name of Owner of premises .~..& ......... a.~3.e.b. ......... Address ........ ~o~t.¢~<~(]. ................ Phone No ...................
Name of Architect ...................................................... Address ............................................ Phone No ...................
Name of Contractor ...... ~e..~ .................................... Address ............................................ Phone No ...................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro,
property hnes. Give street and block numbers or description according to deed, and show street names and red,ca-
whether ,nterJor or corner lot.
STATE OF NEW YORK,
S
S
COUNTY OF ......... ~1..~ ~.. ~lf. .....
~~¢~....~~ .................................... being duly sworn, deposes and says that he is the opplic,
(Name of individual s~gning apphcot~on)
above named. He is the ........... .Q~f~0.~;~. ............................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and ~s duly authorized to perform or have performed the so~d work and to make and
th~s application; that all statements contained m this opphcation ore true to the best of his knowledge and beli
and that the work w,ll be performed in the manner set forth in the apphcot~on filed therewith.
Sworn to before me th~s
.................. .'l~)... day of .................. Oej,l;.o~ ........' 19"66' ..~'. ~/~/~/~ /~~ ~,~¢.~¥.~-r.....~.~z_~.n.~..~.. ~....~....~
No,ory ..... ........................