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Home My WebLink About3137-zFOR~I 1~0. 4 TOWN OF SOUTHOLD TOWI~ CL~'--RK'$ OFFICE $OUTHOLD, N, Y, P~E~TIF~O~T~' OF OOOUPANr.¥ No. Z.. 2 .~..1+. .... Date ................ .0.(~t;P. ber...],~., 19.(56. THIS CERTIFIES that the building located at . Blo~mom .Road .............. Street Mattituek ~at~ea Map No ............. -~loc~ No ............. Lot No .... 26.~.. F~tf~l/aok~..~I, ...... conforms substantially %o the Applicati,on for Building Permit heretoSo,re filed ~n this office Oatea ...... ~ ...... 28 ...... 19.66. pursuant to which Building Permit No...3~. Z dated ............ 4~...2~..., 19. ~, was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .o,ccupancy ~or which this certificate is ~ssuea ~s..~r~. 9~..f~.~Y..4V~.ng ......................................... The certificate is issued ~o .gd~..Abltz..C~atrae~r. 2~ ........ ~e.~ ........... (owner, lessee or tenant) of the ~ore.said building. Suffolk County Department of Health Approval . .0~tobeT ........ ~966..b{ .~, .~i~la BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 3137 Z Date ................................. Permission is hereby granted to: Edwa~ ..Ab&t,~..Oon.tr. ae'~o~,.. (~me ................. · ....... t~ie~..t.i~u¢~ ................................................... to....~...$ ;1,. ~ .. ~..~....q.~...~'~.~;L~:...~:~ ~1 &~g ..................................................................................... et premises located at .........~,.....;~i~r.....~e~g.~.ek.....~.t,a~3 .................................................. ................................. ~/.~.,....T~l~s~m...~e.~.~ ........ P~,~.~i%ue/~,~ ¥.~. ............................................ pursuant to application dated ......................... J~/~%~....-~ ................ 19~..., and approved by the Building Inspector Fee $..~Q ,D.Q .......... sCHD Su~'FOLK COUNT~ DEPARTME~ OF HEALTH TO WHoM IT MAY CONCERN: Dat%~ ~ ~~ Bldgo Permi% Noo~ ~ ~/ The sewage disposal facilities for a structure located at (Give deed location) '-~' ~ have been inspected by this Department and found to be satisfactorv. District Engineer .... D~strtc~ ~ng _ee~ FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. " Approved t x 19 ........ Permit No. Disopproved o/c ............................................................ . .................... Application No..~,J..,,~,..,,~, .......... APPLICATION FOR BUILDING PERMIT Date ,Tune 28 1966 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end 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 drown 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 sh~ll be occupied or used in whole or in port for any purpose whatever until o 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, end other applicable Lows, 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) ........... Ma.~itmok.,.....N.,.~, ............................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................ Q~er....-....b~ilder. ................................................................................................. Nome of owner of premises $.~,~,~.~..Al~J;~...~..O~.~.~.~.Q.t.o.~...~...q.e. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name end title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...~4~.~ti.t~¢~..~.t~,.t.e~%t No.: ....;~.~. ............... Street and Number ...~to-~.g~...]~e~ ................. }~'s~t.~.t,',z~...N.,.~r., .......... ~ ..................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ....... l~'a.~aDJ;...la.tn.~. ................................................................................................. b. Intended use and occupancy ....... O-"l-e...~'~.m~'l~...rl~il-~n*~ ........................................................................... 3. Nature of work (check which applicable): New Building ..:F,.3ET,~ ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........l~.~.~'g.0 .................................... Fee ...3.0 .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... Om ................ Number of dwelling units on each floor ............................ If garage, number of cars .............CiZ~ ......................................................................................................................... 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 .....2.~..-..~. ......... Height .................... Number of Stories .............O~e ................................................................................................. 9. Size of lot: Front ....... ~D{~ ............. Rear .......... .~.0...0. .................. Depth ....~.~.....c)...~. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......... t!.A.~!...(]..£$.~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ nO ........................................... 13. Nome of Owner of premises .....~..~..W...~.b.~.~....C...°..trt...~?.,a,~att~s~ .~.O. ....... ..~.~..l;.~..J_.~...O.~ ....... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ......... ~i~f~ .................................. Address ............................................ Phone No ..................... 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 :;reI STATE OF NEW YORK, ~ S S COUNTY OF ..~13,~.11c ............. ~ · · ......................... ~.~.~.~,~'.¢1,..~,~1,t~E .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing al~plication) above named. He is the ............. o.1~-z3.e,z*.....]~.lJ.J,'l C1,~ .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the opplication,,,N't~therewith. Sworn to before me this /' /~,~ ~ .. ~ ................... o ....................... ............ ~10, 52-3233120 Suffolg Caul;ly ~rm Expires IV[a[ch 30, 19/~.,~