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NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. Z..2~.30 ............. Date .......................... ~1'1~1~1~ ...~,9 ....... , 19.67...
THIS CERTIFIES that the building located at .13al~t,~e...ll/8,]lt' ...................................... Street
~ ~.$.~...S.*..~t~k No ........ ~ ..... ,or No 2~, ....... ~tt~t~,..~,X, ................
conforms substantially to the Apphcation for Budding Permit heretofore filed in th~s office dated
............................ ])~1~, ..... ~.. , 19.~.. pursuant to wh,ch Bu,ld,ng Perm,t No ..~,~..~
dated .......................... D41e.~....~l,6 · .., 19 6~., was ~ssued, and conforms to all of the requirements
of the apphcable prows~ons of the law The occupancy for whmh th~s certificate ~s ~ssued is .....
.... P.~Lva~ on~..£mn/.l~..~~g ...................................................................................
The cerhficate is ~ssued to ..~1~..~0 ................. 0-~'te~ ..........................................................
(owner, lessee or tenant)
of the aforesaid building
by R, ¥tlla
FOR~I NO. 2
TOWN OF $OUTHOLD
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? 3342 Z
Permission is hereby granted to:
............... ~..s.k.oz....z.~..e. .........................................
................. g.~..~.e. ~.~.e.~. ~.....~ ~.~..e. ........................
................. ~ram~.....~.,.~(~ ..................................
to ...~m~,:L¢..~...~'.~...f.~ ~,~....~,'.~.~. ~.~.~.~ .................................................................................
at premises located ct ,.~.~,.....~.~.~ ........ .~.~.~..t,...~.~..~..~.....~..s..'~.a.t/..~.~. ......................................................
.................................... We.~e...cr.e~t..L~ne, ....... [4a~t£~uc.k.,...H.,.~.,, ...........................................
pursuan¢ to application dated ............................. ~.~..~..~...m..b..~...l'......!.~...., 19....~...~., and approved by the
Building Inspector.
S-9
SUFFOLK COUNTY DEPARTMENT OF HEALTH
~te, / ~' - ~ -/~,~
Building Permit No. ~ ~ ~-
TO WHOM IT MAY CO~:CERN:
The sewage disposal facilities for a structure located at
(Give deed location)
~,!/~ u' ~ ¢,q ~ ~ ~ ~ ~ ~' ~
have been inspected ~ this Depa~ment a~ fo~d to be satisfactory.
~ 1 ~ 19~ Distriot ~ineer
"'"' '" District Engineer
Tdle No S-203:5~1-3
NOTE I = MONUMENT
SUBDIVISION MAP FILED IN THE
OFFICE OF THE CLERK OF SUFFOLK COUNTY
ON AUG :5, 1966 AS MAP NO 4582.
SURVEY FOR
THOMAS J CAHILL
LOT 29
"SALTAIRE ESTATES"
MATTITUCK
TOWN OF SOUTHOLD
SUFF. CO, N Y. GUARANTEED TO'
INTER-COUNTY TITLE GUARANTY
SCALE 1"=40' s MORTGAGE CO.
RIVERHEAD SAVINGS BANK
JUNE 13, 1967 ER AND
LAND SURVEYOR, N.Y~. LIC. NO. 128-
RIVERHEAO 1 N.Y. ,
FOKM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ , 19 ~ ~o
Approved ........................... ~ ............ , 10....~.... Permit No.................. ~ ~ ~ ........ ~'"... ~'
Application No. '~ ~/"1 ~
............... (Building Inspector) {
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 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 (3 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 (3 Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment 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 oil applicable laws, ordinances, building code and regulations.
(Signature of applicant, or name, if a corporation)
........
(Address of applicant) J
Stote whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
............... ...............................................................................................................................................
Name of owner of premises ....... ~<z'"t"~ ......................................................................................................................
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. MopNo.: ..~.~.~.i~.[.~.]~)Lot No.: ...~..~ .............
Street end Number ......... ~..~.~..~..,~,~,~.~..J.,:,.,.~.~.[..~.[ ........................................ ~..~-~-,~,.~. .....................
~unici~lity
2, State existing use and ~cup~ncy of premises end intended use and occupancy of pr~osed construction:
a. Existing use and occupancy ...................................................................................................................................
b. Intended use and occupancy ..............................~ ............... 9....~..-.-~- ..............................................................
3. Nature of work (check which applicable): New Building . ...~. ...... Addition ~ ~ teration ..................
Repair .................. Removal .................. Demolition ......... : ........ Other Work (Describe) ~
4. Estimated Cost ......... ~p.....O. ................................ Fee ~"
(to be paid on filing this application)
5. If dwelling, number of dwelling units .....~.....2~........~=... ...... Number of dwelling units on each floor ....o.....~....~. ..........
If garage, number of cars ............... ~..2~......~:... ...........................................................................................................
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 .............. ~....~.. .............. Rear ........ ~....~.. ........... Depth ~.~.....~../~....
Height .....J...~. ......... Number ~)f Stories .~. ,d ~
9. Size of lot: Front ......... /.~...~.. .......... Rear ........... /.~....O.. .............. Depth ..... .~..o..9.. ................
10. Date of Purchase ................... 1.~. ....... 5. ....................... Name of Former Owner ...... .-,~...~.......~,...~..(~...~.....cl .................
11. Zone or use district in which premises are situated ............. ~..Z..~../..~...~.~'...~...L..~.....~ ...................... Z .................
12. Does proposed construction viobte any zoning law, ordinance or regulation? .......... .,f~.......O... .......................................
13. Name of Owner of premises .~.~..~..~..~..~....../.~..'....Address J~.d~..~.~...~.,~...~..~. ............ Phone No...72~.~...-/?~ Y'~
~,~F-~ '~ c ~- .......
Name of Architect ...~ ............... ~ .................... ;.,~..i..Address ' 'i~'~'~' Phone No .....................
Name of Contractor ....... I...~./~.(.L~...~.~./2.//~:.....C..Address ~.'~i.'~.~'i~i~.'.?~..'.. .Phone No.'7.~..~..: .~..O...?..~-
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
i~.ao
STATE OF NEW Y.~RI /,/._~' 1¢¢ -
COUNTY OF
................ '"~'~,¥...,.~.~ ' '"~ ..................................... being
(Name of individual signing application)
duly sworn, deposes and says that he is the applicant
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 file
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to~be/fore me this ~r')~_ ~,__ ~. ~ ~ ~ /7 '~
..... ..... da:, .......... ........ -
Notar Pub c , . ' ......... ~'~'"'"I~ ...........................
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