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HomeMy WebLinkAbout2262-zFO~M NOo4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFiCATe OF OCCUPANCY THIS CERTIFIES that the building located at E/~..~est..~lz~c~..De~p..HoZe...Dr.. Street Map No ...... ~ ....... Block No .......~ ...... Lot No. ~ ...... ~;~.t,~,,t......}~'~(~'~ ............... conforms substantially to the Application for I~uilding Permit heretofore filed in this office dated ...................................... .~..O..?..e...~..~..e...~....2.~..., 19..6~... pursuant to which Building Permit No ..... .~.~.6..~...~. dated ......................... ~O~e~......~.c).., 19..~3., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .... ~..t.~.C...e.....o..~.~....~.~.~.Z.~...~.~c..z...!~..n.g. ............................................................................................ The certificate is issued to ...l~d.~t.~.d...F~,...Gr.a~l.~ ......................... O1~er. ......................................... (owner, lessee or tenant) of the aforesaid building. H.D.Approv~l April 20 196~ by R, Villa ........ .................... Building Inspector j r FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST B~,K[PT ON THEPREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2262 Z Permission is hereby granted to: Ed~...A~,t~.... ~/¢.....Ed~,...F.,...~a~¥ .............. at premises located at..,..~....~/...]~Z'.~.¢b...D~,~...~].e,.,;[;~'.;[V~ ................................................ ................................................................. ~a.Ct £%u~k ........................................................................... pursuant to application dated .......................... .~'0.'¢~e~.....2~) ...... 19~},.., and approved by the' Building Inspector Fee :~, a ,Q~, ........... ...... _~.,. ,~......:~...t.. ......... :~::.::~.~ .................... Building Inspector ~' SCHD SUFFOLK COU[@Y DEP~-kT~,~ENT OF HEALTH Date April 20.,_~96h _ Building Permit No. 2262Z TO ~v~OM IT MAY CONCERN: The sewage disposal facilities for a structure located at 1~OO' s Suffolk Ave e/s D$~p Hole Dr, Mattituck "(Give deed location) have been inspected by this Department and found to be satisfactory. District Engineer FOItM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom,ned ....... ........ Approved ............................. .t.~ ........ , 19.....~!..Permit No. ~-~:~ ~ ~ 7---- ~ I ' ....................... ................................. APPLICATION FOR BUILDING PERMIT Date .................. .N.p. Me...m..b...e..r.......2..9 ......... , 19...6.3 .......... 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 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 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 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 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. Edw Abitz (Signature of applicant, or name, if a corporation) ............. i'f~t.t£ 2.~c2 .............................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. contractor Edw. F. G~a~ Name of owner of premises ............................... ~ ................................................................................................ 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: ........ .X:~. ............................ Lot No: .....~X:g~ ....... Street and Number ....:',/~......~L~...br.a:ae.~..gaep...~o_-La..ctm~ .......... Mat.%i.~.uck ................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~acant tsnd b. Intended use and occupancy 9.2.~. 3. Nature of work (check which applicable): New Building .... ..~..~.~..~.'.... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ........... ~.bc..~.~.~.Q .................................. Fee ....~0. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .o..~...~. ................ Number of dwelling units on each floor ............................ If garage, number of cars ................ Q~e ............................... 6. If business, commercial or mixed occupancy, specify natureand 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 ......... ~.~. .................. Rear ......... ~.~. .............. Depth ......~..LI:..-..~. ............ Height ............................ Number of Stories....~.~ ....................... 9. Size of lot: Front ....... ~Q0 .................. Rear ....]..Q0 ................. Depth ............... 1.~.0 .................. ]0. Date of Purchase .................... ~.¢~..~.3 ........................... Name of Former Owner .......... .Z,..~.~.(!~.~ ............................. 11. Zone or use district in which premises are situated .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... D.o. ................................ 13. Name of Owner of premises .~.~.¥.:.....~.~.. .............. Address c)0]_~ '1~65¢ ~{~Z] ±$ Phone No. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ .~.¥....A...~.~.~ ...................... Address ............... .~.'!~..~.~J:.~.~...~.~ ....... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 YORK, ) COUNTY OF ....~..~...~.~.9..Z..~.. ........ ) S.S. ................................ ?.:~.¥.,...~.~..J-.~ ......................................... being duly sworn, deposes an~d says that he is the applicant (Nome of individual signing application) above named. He is the ............... .Q~T~.~'.~,.q.~s.~Z'. ................................................................................................................. (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 file this application; that all statements contair~f~d4 i~ ~bj~application ore true to the best of his knowledge and belief; and that the work will be performed ,in th,e~ma~ter0~s~tWffc~h in the application filed therewith. Sworn to before me this t~0.52-u344963, Suffolk County i_,~ .,,c, ..2-9 d yoo f ...................... ' ..................... , 19..~.~.. ...................... ~ ...~ ~-..-,,,/~., ~ ................ ~...~..~......,c~.>.J.: ......... ~ ....................... Notary Public, .~.~Z...(.~.;.~Co~unJ~y _ ~ (Signature of applicant)