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Home My WebLink About2790-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... 2.2'79'.:~ ........ gate ................... 0c.to.~er..... 16 ........... , THIS CERTIFIES that the building located at ..E/~]....),q~t,~.~...~r):L'. ............................. Street Map No...:~:.:~ ...........Block No....X~ ......... Lot No..:~r,~ ......... ~a.t~,.l.t;~l.G~ ......................... conforms substantially to the Application for Building Permit heretofore filed in this office d~ted .................................. '~.~I~ ....... '10 .......... , 196.~... pursuant to which Building Permit No. dated ................................ ~' .1Ete......]:.O....., 19-6.~'.., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... Private...o~e...~amf'l~'..~}w~.in~ ........................................................................................... The certificate is issued to ..~:~..l{]...l~'~k~.~.~ ................... C~/tr~'~ ........ : ......................................... (owner, lessee or tenant) of the aforesaid building. H.D.Approval Oct. 15~ 196~ by R.Villa ......... ~:~ ~.~ ~i~.~' ... /'~"' ~u,d,~g In~;';'~I' ...................... FOI~M 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.o 2790 z Permission is hereby granted to: A,...~.e.~,I~Z...~...S..o..n...~.e.........A~...C......P...°.."...-a!...~.. ............. I~.~,.~u~k ............................................. to ...ImJ,:t~.. ne.~., oae...£~'...d.~e ::L3.~.n~ .................................................................................... pursuant to application dated ~'tl~e LO 19....~...~. end approved by the Building Inspector Fee $... ~.O.e.O~. ........ Building Inspector SUFFOLK COUNTY DEPAR2~ENT OF HEALTH OCT 15 1965 D~te TO WHOM IT MAY CONCERN: The sewage disposal faciliti~es for a structure located ~at ~,ve been inapeet, eO. by t,h.t.s Depa.rbm~nt ~ncl fot~nd to be s~tisfaef, oz3% District Engineer FOI~M NO. 1 Examined . ....... .~......., Approved ~ ................................ , 'TOWN OF $OUTHO~.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No. ~ O ~ (Building ~i · 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 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 po.rt of this application. c. The work covered by this application may not be commenced before issua.nce 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 shah 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 the BuiJding 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 comp y with a applicable laws, ordinances, bui ding code and regulations. ...~ailly...&.. S. on,....Ia¢ ................................................ (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, generaJ contractor, electrician, plumber or builder. ....................................... g. omtrac.~or ................................................................................................................................. Name of owner of premises .....l]oz~ald..l~lze3cle¥. ............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of lend on which proposed work will be done .Map No.: ....... ~ ....................... Lot No.: .~ ............. Street and Number ..... ~Z~.....~.~.~..g~.$~.~ .......... ~.~.~.~. ........................................... ~-. ..................... Municipality 2. State existing use and occupancy of premiFes and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.&g.~..~q~. .................................................................................................... b. Intended use and occupancy ....... O~fl..~...~.~.~.~.~ ............................................................................ 3. NatUre of work (check which applicable): New Building ...~.. Addition .................. Alteration Rep?ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estirhated Cost .....~.~.Q.O.. ......................................... Fee ..... 1.Q .......... (to be paid on filing this application) 5. If derailing, number of dwelling units ......... axle ............ Number of dwelling un,ts on each floor ........................ If garage, number of c~rs ........................ oz~e ..................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Hei~lht ........................ Number of Stories DimensionsL of same structure with alterations or additions: Fron{ .................................... Rear Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~'P .................... Rear ......... .~'~ .............. Depth .26/...~'.Q .... Height .................... Number of Stories ............ 9. Sizel of lot: Front ........ .~..~' ............... Rear ............ ~..~' ................... Depth .....1..3.¢ ................... 10. Dot9 of Purchase .................. ].~).(:l~'. ........................... Name of Former Owner 11. ZonleL or use district in which premises are situated ...... 12. Doe~ proposed construction violate any zoning Iow, ordinance or regulation? ............... ~.O ............... 13. Nar~e of Owner of premises ..;Don~[hcl..]3Ll~;1.e~r....Address ....... ~T~sp.c~r..t, ............... Phone No. Name of Architect ..~.....,~q.:l.~z'.~ .............................. Address ............................................ Phone No. Name of Contractor ....... &,...]~i,J,3~. ....................... Address ......... ~..~¢i.¢UeJ~ ............. Phone No. PLOT DIAGRAM Locat~ clearly and distinctl; all buildings, whether existing or proposed, and indicate all set-back dimensions property Hnes. Give street and block number or description according to deed, and show street names and whether inlerior or corner lot. STATE O~ NEW YORK, } ~ ¢ COUNTY. OF .S~'~'.O.'I~ .............. J ~'~' ........................... N.~ma~..R$.t~)r. ...................................... being duly sworn, deposes 'and soys that he is the applk (Name of individual sigmng application) above named. He is the ....... (~.Q~J;~Cz~QZ' ...................................................................................................................... (Contractor, agent, corporate officer, ¢c.) of said o~'ner or owners, and is duly authorized to perform or hove performed the said work and to make and this appli~ arian; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ 2rk will be performed in the manner set forth in the application filed therewit~ Sworn to efore me this ~ ¢* ~¢ ~, ~. ~ ~ ............... ~0... day of ...................... Z~ ............, 19...6.~. ' ~ / _ /Y ~ '~n/ .~ ' ......... v .......... ............ ..... Notary Pub c, ~...~., ............. N A.,R~C~b~T ~ ~ (S gnature of app t ~ ~0. 52-3233120 Suf~oI,, ~ ' ~ it-~, {1'~ \ II L L