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Home My WebLink About2121-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....... C~c~,r...Dz',tV~ .................................... Street Mo~or~..~?.~?.?.. ..... Block No ............... : ....... Lot No .....1.C~...ll ....... J//~,t~.~J,.~.~kt......J~.,..~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... J~,~l~. ....... 22 ....... , 19~..6~ pursuant to which Building Permit No ...... ~.~,~...~ dated ........................... ~/'.~l,~.....;~2. ......... , 19....~.3, was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ . .Pr.i.v.a.t.e...(m~, .. family...dwe.].ling ............................................................................................. The certificate is issued to ......~?,,.~,pe~ce~.....~'t.~z,.~o:z~.t~ ........................ 0.I~1~. .................. (owner, lessee or tenant) of the aforesaid building. H.D.Approval Dec. 12~ 963 FORM NO. 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°. 2121, Z Dote ............. ~'.'0~. ....... ~'~ ,..... ~,~3. ...... 19 ........ Permission is hereby granted to: .... ~,.~.e.~..,..~.~......~...~.~..e.~?.~. ...................... Mattituck to .. Bu~.l~...~.e.W....o..n...e... ~.~..~.~.. ~.e..~ .Z. ~..n.g. ................................................................................... ot premises Jocoted ot .....~uO.~..,~O..&..~.S.....~t'~.O~..~Q~'~ ............................................................ ............................................... ~ec~=~...~=.~.ve.s .......... ~e~t,~.~.~e~ ..................................................... pursuont to opplicotion doted ...................... ~:~.~.~. ...... ~ ..................... 19.~,~.., ond opproved by the Building Inspector Fee $.10. ................ SUFFOLK COUNTY DEPARTMENT OF HEALTH Date .... ~oce~beM 12~ ,1963 Building Permit No.,,, . 2121Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ,Lot~ ~]O snd ll,Mattituck Devel~ Co~ Cedar Dr~ve. Mattituck ~ (Give deed locati~n) have ~een inspected by this Department and found to be satisfactory. ........ Dmstrmc er TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................... , 19 ........ Permit No. (Building inspector) Application N~ j APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 odioining premises or public streets or areas, and giving a detailed description of layout of property must bedrawn on thediagram 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 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 pa 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 o 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 oll applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) .................. ......................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, ~le, ctrician, plumber or builder. Owner - builder Nome of owner of premises .~..* ~..P..~.~.~..~. ]~.~;.9,.:~;~.D~. . , ~ .......................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 2 Location of lend on which proposed work will be done. Mop No: .J~O~.e..J~'~ ........ !, ....... LOt No: hAunicipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy vacant lot , -. Intended use and occupancy D,TI~ £a~;LZy...duelltz~g , J 3. Nature of work (check which applicable): New Building ....... ~1~.~. Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estirhated Cost .............. ~.~0.Q..P~.M ........................ Fee ......... I0. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....O.~'le ................... Number of dwelling units on each floor ......................... If g~rage, 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 ........................... 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 .............~.0 .............. Rear ............. ~0 .......... Depth ...~0/~. ........ Height ............................ Number of Stories ........ ~2 ................... 9, Size of lot: Front ......... ~.Q0., ............... Rear ........... ~Q0 .......... Depth ....... ~0 .......................... 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zone or use district in wh'ich premises are situated ............................... ~...~8~ ............................................ 12, Doe~ proposed construction violate any zoning law, ordinance or regulation? ....... ~ ..................................... 13, Name of Owner of premises,~...~.~.*~.~O~.~Address .......... ~&~ ............ Phone No ................ Name of Architect ............ :";,r .............. ~' ...................... Address ............................................ Phone No .................. Na~e of Contrador ..... ~'~.L~:.L' ............ ~ ....................... Address ............................................ Phone No .................. ' ~ PLOT DIAGRAM Locate clearly and distinctly &Il,buildings, whether existing or proposed, and indicate all set-back d mens Ohs fr~ property hoes. G~ve street and block numbers or descnphon according to deed, and show street names and md~ce whether in(erior or corner lot. I STATE O~ NEW'YORK, ' ) ......................... ~,, ........... ~ ...................... ~. ................................. etn~ duly sworn, deposes ~nd s~ys ~h~ he is Che ~pp[~c~ (Nam~ of indlvidu~l si~nin~ ~pplic~fion) ~bow n~med., ~e is ~ ................ ~..~...~,~ .......................................................... ~ .................................... ' ~ ! ' (Contractor, agent, corporate off car etc ) of sa d owner or)ownprs, and s du y aut~er zed to perform or have per¢or~ed the sa~d wo~¢ and to make and ' this a,pp[icbtioq~ tha~ all statements cont~in~ application are true to the best of ~is knowledge and bell and that t~e ~ork w~'Jl be performe~ in,t~li~8~.~.~th in the application filed therewith.