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Home My WebLink About2130-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...l~.~.....~e~..l~l~.o],ie..Ave. .................. Street Mop No...,XA',.~ ......... Block No..~ .......... Lot No...Y,,~[ ............ ~,¢~.'~Ji,.~.,1ACf~t......~.,.~.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ,~rl~,~,.y. ......... 2..~ ......... , 19.~.~.. pursuant to which Building Permit No. dated ............................ ,T~,,Xl~,.,..2~6 ......... , 19..~..~., was issued, ~nd conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ................ Pr.l~a.~ .~... ~n~.. £ar~,L !,~... ~,~e!l~,~g ................................................................................ The certificate is issued to .....,~,...~e~Lt/:l, zL.~ar~s~t ................. {)M~ne~. ............................................ (owner, lessee or tenant) of the aforesaid building. H.D. Approval Dee 9 ~ 1.963 FOI~M NO. 2 TOWIq OF SOOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2130' Z Dote ...................... Permission is hereby granted to: .Ao..~.~.~ff~ ....................................... .... ........................................................... .............. ~.~k ................ : ............................ to ....'~o...~u:t.~d...ne~.. ~ne .. -.t'~m~:~.. ~e~.~.r~ ........................................................................... at premises rocoted at '"~//~""'~"~'~' ',~l?"A~e ......................................................................... ...................................................... ~-t~.t,~,~.... ~ ¥~ pursuant trO application dated ............................ i,T~~. ...... ;~. .............. 19~..., and approved by the Building inspector Fee $"~l. OitO(~ ......... 'T~ ~-' 'Buiiding Inspector S-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH Date December 9. 19.6.3 ..... Building Permit No._ . TO WHOM IT MAY CONCERN: The sewage dispesal facilities for a structure located at New Suffolk Avenue & Zaneski Lane, Mattit~ck ~ Owner ~ Hansen ....... (Give deed location) have-been inspected by this Department and found to ~e satisfactory. District EnEinee~ TOWN OF SOUTHOLD BUILDING DEPA~TN4~ENT Town cL,. 'S omc ..................... Approved ..................... ~...~ 195~.Permit 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 p remises, relationship to adioining premises or public streets or areas, and 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 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 Bqilding 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. ..... ............. (Signature of applicant, or name, if a corporation) ...... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. .G~:..~.¢7.74 4:...~' .................................................................................................................................................................. Name of owner of premises. ~.(. ~.~r~..~ ~¢~J :: (. ........................................... 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 ....... ..... :.5....~....~-:..~:..~.x:'Z,~..~'.:..Z'../. ......... /.;;~.:~...x/~. .................... Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ;.../~.~...~../?/.. ,~...,~/7'(.~./.~.. ............................................. b. Intended use and occupancy 3. Nature of work (check which applicable): _New Bui!dincL .................. Addition .................. Alteration ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost __;.~.4~,~,,,~.,_.,~., ........................Fee ....................................................................................... (to be paid on filing this application) 5. If d~elling, number of dwelling units ............ ~ ............. Number of dwelling units on each flor .......................... ff garage, number of cars ............................ ~ ................................................................................... If b~siness, com~rcia] or mixed occupancy, specify nature and extent of each type of use ............................. Dimensions of existing structures, if any: Front.....~..~;~..~. Rear ....~'~.~;~¢:;Z;.. 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......~,j..&~¢r~; Rear ...... ~..J.Z~;Z~?~Depth ..... ~ ............ Height ..... ~zZ~cz~.,. Number of Stories ........ ~ .................. 9. Size of bt: Front ..,.~..~..~ Rear .,Z.~ ........ ~.. Depth ~ /~;~z ...... Z..~: ......................... 10. Date of Purchase ....... 2.t..~.~Z.~.~. ......................... Nome of Former Owner .~CC~4.....~Z~.~ .... 11. Zone or use district in which premises are stuoted . ~~.~.~ ......................................................... 12. Does proposed construction violate any zoning iow, ordinance or regulation? ............ ZK.~ ............................... ]3. Name of Owner of premises ~r.~L4~4z(<..~¢/~.ccAddress .~Z....~..~.~ .................. Phone No. Name of Architect ~Z~q.~......~fiZ ............ Address ~v~7..g}~z~.~..~e.~.~YR..~tf?Phone No.~ff.~J~Z Name of Contractor .................................................... Address ......... f'L~.~.V/~ ............ Phone No. PLOT DIAGRA,M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indicc whether interior or corner lot. STATE OF NEW ,~'O~,,/Z , ) S S COUNTY ~OF ~,..) · ' ...... .4,~..x.,4~:~J~...~~..~.. ........................... being duly sworn, deposes and says that he is the applicc (Name of individual signing application) above named. He is the ..................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and t this application; that all statements contained in tK~ ~cation are true to the best of his knowledge and bell and that the work will be performed in the m~¢~ ~ f~the application filed therewith Swort to ~ fore me th s ~ ~2.0344963 Suffolk County ~ ~ ........... ~..,~. day of ............... ~ .............. ~ 19~ ~/ ~ . ~' ~/p/ . ) ~ ~, · / ~ ~ ] ........ ~..<..... ~......~~.~ ........ Notary Public, ~~..~_~.~~~~ (Signature of applicant)