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Home My WebLink About2918-z1*01%1t[ NO. 4 ?OWN OF ~OUTHOLD BUILDII~G DEPARTMENT TOWI~ CLEEK*S OFFICE SOUTHOLD, ~. ~Y, CEI~.TIFII~ATI~ OF OOOUPANOY No. Z 3049 Date Apr11 5, .6.8. Mat;t;Lt:uck, L.I., No Y~ Map No ............. Block No ............. Bot No ..................................... conforms substantially ~o ~he Applicati,on for Buildin~ Permit hereto~ore fi]ed ~n this office dated .......................... ~9 .... pu.rsu'ant to which Bufld~n~ Permi~ No .......... Nov. 3, 65 ~ated .......................... 19 .... , ~vaa issued, and conforms to all of the require- ments ,of th~l~l~ble, ur4~.visions of the_ ~akV. The ,oe~klp~_ncy for which this certificate is p 1' Ge ~l;Qalo o1~ olte ~:amlay awelzLng issued is ........................... t4tlliifd 'H~gg~li ................................. The certificate is issued t.o ................................... v.'.-~. ........... (owner, lessee or tenant) of the afore,said building. ' ..... ,Suffolk County Department of Health Approval ......................................... Building Inspector 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? 2918 z Date ............................. lV~v. em~xer.._.3....., ~.~5... Permission is hereby granted to: ................... Nat~itmek ...................................... to ~xLl. d...new...m.t, ud_~o/apa~.~.t. & ..~arag~.. bu&],d~.r~ ................................................... at premises located at ...~/43.....~t~i..l~oa~.....Nl~,.t~:~k.t...~i..~r ............................................... pursuant to application dated ............................ ~O~ ......... '3 .............. 19..(~., and approved by the Building Inspector Fee $...Z..9.."...0..0. .......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. y. Examined ...~..~ ................... , 19..~.?. ' Approved ........................................ , 19 ........ Permit No ...... Application No. ~' ) ! ~ Disapproved o/c ..........~~ ......... ~T .............................. - APPLICATION FOR BUILDING PERMIT Date .............................. 19_6.5; ..... 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 Ix~rt of this app ication. 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 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 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 w th all applicable laws, ordinances, building code and regulations. ---- ~ .. $.~ s.eDh ....~e.e.~ko skl ..................................................... (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ..................................................... g..o~l.tr.~c.~ or. .................................................................................................................... Name of owner of premises .WJ.11a~d..weg~ez~ ................................................................................................................. 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.: ....Y,~3~. ............... Street and Number .~.8.....Mal,~..P, oa~ ....... ~.tti.tu~.k ................................ ; .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....v.a~az3.~;...la~-ld .................................................................................................... b Intended use and occupancy ....... mn~..£mmd, l.y...d, we.lld,n~ ........................................................................... 3. Nature of work (check which applicable): New Building ...~,,Y,~ ..... Addition .................. AIterotion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .~.8.~.0.0.0. ............................................ Fee ..].Z] .................................. (to be pa d on .................. 5. If dwelling, number of dwelling units ...... One ............... Number of dwelling units on each floor ............................ If garage, number of cars .............. ~'Wa ........................................................... . 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 ........ 6J~w.~. .................. Rear ...... .~...8. r.~ ............ Depth ...~.-..~ ........... Height .................... Number of Stories ...... DriP_ ................ ........... ........~ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ I 1. Zone or use district in which premises are situated ..A.....dfl. s.~ .......... . ............ 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~.Q ............................................. 13. Name of Owner of premisesl~'ill/~..fl...~eg~,en. ...... Address ............................................ Phone No. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..3'~se. Db,.3)~e~k&. ........... Address Mattiuck Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether it~terior or corner lot. STATE OF NEW YORK, ~SS COUNTY OF ..... D. lz-f't~O3~ ......... ,f ' ' ............................... J.o~e~'~..~ee~.k~sk.~. ......................... be ng duly sworn, deposes an~l, Says tho¢ he is the applicant (Name of individual signing application) above nomed. He is the ................... Con.tr,~. ............................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfOrmed the said work and to ~:ke and file this application; that all statements contoined in this application are true to the best of his knbwledge and belief; and that the work will be performed in the manner set fo~h in the applicati~ filed therewith. Sworn to before me this ................ 3 ...... of ............. __ ,, ~o~ary pubtic, State ~ ~.e~.,,, .... ~ ~ ilo. 52-~34496~, Smm~ ..... ~9~