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Home My WebLink About3026-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. EF~TIFIP. ATE nF or':.I~.UPANP. Y No.Z .28~?~ ..... Date ............ fief, el)CZ'.. 20.., 19 67. THIS CERTIFIES that the building located at ~/S.. ~lll=tt .I~I'~OI'. l~al~.. Street Map No..Z~...: Block No.. ~E][ ....... Lot No..][][ ..... 8Ol~hel~f .ll,~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office ....... , Permit No..~02~ .X dated -- I~l'¢h. -'23- 19.66 pursuant to which Building ~O~ ezS~l~lt, ttOltl dated .......... l~al'ch... 2~.., 19.66, was issued, and conforms to an]G[ll~reqmre- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~'.~-va re- .o~e- -f-a~t.]:¥ · ~l~e~ l~g ....................................... The certificate is issued to .idi] .Liaa---1)ezevela ...... 0~nel, ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .P~b.l:[e..~&te~..1. ]~ .o~hel'. al~l~l'o~'al Building Inspector FOI~FI NO. 2 TOWN OF SOUTHOLD BUILDING Dt:PARTM[NT 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? 3026 z Date ............................. ~,4aX%C~X....2~ , 19~... Permission is hereby granted to: ...... 3.~.~.,....~.O X~2.. ~.S ~-.A,V.e ................................... ............. ,5~3~¢l~:~.s~.r .....~ ~, ............................ to .~ .%.~ ....n..e.,~ .. p...n..e.,....f..a. ~.L .l.~...~.e l~,~g ...................................................................................... at premises located at .,~/f{.....S~zLth..f[az'.bozc..,.~oa~ ...................................................................... ............................... ,S..o...u..%}~p..%.c!.,...,,.~f.,.~.~ .............................................................................................. pursuant to application dated ........................... ]~.~ ......... ~ ........19~..., and approved by the Building Inspector Building Inspector %~ FOP~M NO. 1 T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. APPLICATION FOR BUILDING PERMIT Application No....,D~.~.~.~ .......... Date .................. ? ......... ~a~.e~ .......:23 ........ , 1966 ....... 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 Iocatiqn of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ahd giving a detailed description of layout of property must be drawn on the diagram 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 Permif}o 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 thel Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or~ Regu at OhS for the construction of buildings additions or alterations, or for removal or demolition, as herein described. '~ The applicant agrees to comply w th all applicable laws, ordinances, building code and regulations. ~ ..... l~il l~.m~ ....DeZaval~ ................................................. (Signature of applicant, or name, if a corporation) (Address of applicant) If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Locatibn of land on which proposed work will be done. Map No.: ....Z,~Z, ............................ Lot No.: ~ ................. Municipality' 2. Stqte existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ', Existing use and occupancy 1/&(h~rt..t,...'l~ ........................................................................................................ State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises .~.'1 l:L~a...~)~a,Va~a ............................................................................................................ 3. Nat~re of work (check which applicable): New Building .... ~.... Addition .................. ~lterat~on .................. Rep~ir .................. Removal .................. Demolition .................. Other Work (Describe)"'iL'~ ................... i ............. 4. Estir ~ated Cost ..~.~/I...D00.....~.~.I~ ............................ Fee ........ ~.O ............................................................................ (to be paid on filing this application) 5. If djWelling, number of dwelling units ....... Or~ ............. Number of dwelling units on each floor .............. .............. If g{3roge, number of cars ........~O ................................................................................................................ ,: .............. 6. If I~usiness,!commercial or mixed occupancy, specify nature and extent of each type of use .............. i ............. 7. DirrJensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories i .................................................................................................. ! ............. Dimensions of same structure with alterations or additions: Front ....................................Rear .............. ; .............. ' Dep! h ................................ Height ............................ Number of Stories ................................ ' 8. Dim~nsionsl of entire new construction: Front ....... (~.~' ........................ Rear ..... ~ .................. Depth '..'~.7". ............. Hei 'hr .................... NumBer of Stories .~ ............................................................................................... ; .............. 9. Size of lot: Front .............. .].OQ ...... Rear .................................... Depth ....;~00 ..................... 10. Dar of Purchase ............ 1~])~. ................................. Name of Former Owner ...T.~:]~ ........................... 11. Zor~e or use district in which premises ore situated ....~,JLd.~.l~ ............................................................... : .............. 12. Doe proposed construction violate any zoning law, ordinance or regulation? ......... 1I~ ................................ ] .............. 13. Nol~e of Owner of premises .1//~,..~.e~t&~.al~l~ .......... Address ...... ~l~d~',~t~.at,...N,,~T~ ..... Phone No .......] .............. Narjne of Architect ...................................................... Address ............................................ Phone No ..................... Na~e of Contractor ....~..~.llt~. ...................................... Address ............................................ Phone No. PLOT DIAGRAM Locat/~ clearly and d~stlnctly all buddings, whether ex~stmg or proposed, and Indicate ail set-bock dlmenmpns from property lines. Give street and block number or description according to deed, and show street names and indicate whether in~erior or corner lot. See filed plot plana STATE OF! NE~ YORK, } ¢ ¢ COUNTY ;OF I~;ll~,~o.~k. ...............f""~' ................................ .~.~..~.e~& ........................ being duly sworn, deposes and says that he is the ~pplicant ~ ~ [(Name of individual s gn ng app cation) ~above na~ed. He is the .............. ~.~,..:,.~ ........................................................................................ ~ .............. /,~ (Contractor, agent, corporate officer, etc.)j of said o~ner 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 w~rk will be performed in the manner set forth in the application filed therewith. Sworr to ~fore me this ...... , .............. , ....... day of ............................ , 1~ . ,'"' Y~]'~/ '~. · . ~ ': ...:.; ...............~_,~~_[j,~;:~,, Notary Pu~lic,~:)~...~..,...L~=~?~.. County (Signgt~e of a~;';~t) j ~ N~TARY PUBHC, St,do o, ~',aw Yon( ~ i j ~o. 52-3235120 Suffolk County , j Term Expires March 30, ~