The URL can be used to link to this page

Home My WebLink About3866-z~O~M ~0.4 ?ow~ oF SOUT~OkD TOWN CLERK S OFF~CE SOU~OLn, ~. ~. [II~f~.TllrlEIAT~ OF CI[I~UDANI:I¥ No.. ~ .33.90... Date ..... .... Dmcelal~lr... 2.4, ..... ,1968.. THIS CERTIFIES that the building located at . .C¢~X .l~k. ~ ............ Street 3/lap No ............. Block Iqo ............. Lot No. ~l~.t;;[i;!tlC. k,..I~. ~..O1~1~ .......... conforms substantially %o the Application for Building Permit heretof, o~e filed in this office dated ....A~.Ig&,I,...3.0, .......... 1968.. pursuant to which Building Permit No. 386~i .Z.. dated ...~.RI;.&~[...$.(}, ......... , 19~i8., ;vas issued, ~/nd conforms to all of the require- merits .of the applicable provisions of the law. The o.ceupaney ~or which this certificate is issued is .1;}l:llralke. one..family..6%~illtnq ........................................... The certificate is issued t.o ...q~l:esa .lhallfl ....... { ................................. (owner, lessee m' tenant) of the aforesaid building. .Suffolk County Department of Health Approval 1~O~.~1~12..7,..J. 9~.lt,. Building"-Inspector TOWN O1~ $OUTHOL~ BUILDING DEPARTMENT TOWN GLI~RK'S OFFIGE $OUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIE FULL COMPLETION OF THE WORK AUTHORIZED) NV 3866 Z v~t, ........ :, ....... ~ ........ -~. ............ , I,...~a Permission is hereby granted to: i t ~I~.~..~..~.~i.....~,~.:...~.~ at premises located at ..~ff~L~l~.~.~4':...... ........... ';; ............................................................ ................................. : ......... l~.~;t.~.o,~ ......... .~,:~,,, ............. ............................................................. pursuant to application dated .............................. /..a]~-~,t~,.,~(.,~., 19'~.~, and approved by the Building Inspector. ~:ee *.~.~ ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date , November 7~ 1968 Bldg. P[ermit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure Cox ~eck Lane o~f ~r~a~ Ave,., (Give deed location) located ~lattituck~ Southold have been inspected by this department and fO~und to be satisfactory. O~-mer Stan]e? f'e]is Builder ~chart~ ~arrjson Approved ........................................ , ........ Permit No ....................... Disapproved a/c .................................................................. 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 descriptioh of layout of property must be drawn on the diagram which is port 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 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 pumuant 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, ordinanc ilding code, housing code, and regulations. (S'gnarure or appdcanr, or name, it a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ..-~....~.....~...~....~'...~.......'.P..~....~...;..~.. .............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) i. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ /~ ,_ ,..~.,~I Street and Number .....~?.X..~........~...~...~..../~.......~.~..~....~....~.......~....~.T..'~/.~..~a.~...../~ ........................................................ Municipality 2. Stye exi~ing u~ and ~cu~ncy of promises and intended use and ~cu~ncy of pr~ con~mctlon: a. ~istlng me and ~cupan~ ........................ 'F' ......................................................................................... b. In~nded use and ~cu~cy .......................... e.~..ly. ........ fi~.~ ........................................................ Locate clearly and distinctly all buildings, whether existing property lines. Give street and block number or description acco whether interior or corner lot. 3. Nature of work (check which applicable): New Building ../~ ............ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ......... .: ....... Other Work (Describe) ........................................ 4. Estimated Cost ...... ----~...b..~..~...o...~..::q.?. .............. ; ............. Fe;..~...~....~....~......(~... .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of c~rs ....... ..~.....tM.~7. ......................... 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 ........ .~...7.. ................. Rear .7...7.. ............. Depth ~....~.. '~. Height ....../....~.'..-..!.~...~ Number of Stories ...... ..0..~......~... ................................................................................. I 9. Size of lot: Front ..........~...! ............. Rear ......... /..~'...~. .................. Depth .....*~.....~..~.--........~T......~.../..'~ 10. Date of Purchase .....Q-..e.l~.i..~.. ............ {.~..~...7. ............... Name, of Former Owner ....J~.~...q.~ ....... ./'~..~./~._~../~... ...... 11. Zone or use d str ct nwhchpremsesarestuated .~' ~../~ 12. Does proposed construction violate any zoning law, ordinance or regulation? ...~...~. ................................................. 13. Name of Owner of premises .T..e-....~..~.-~..~.....~...~...L:~'..~....Address .....~...~.~..ff.q...~...7'$....~... ........... Phone No~.~..7.....~..~.~'...~ Name of Architect ...~. J..~.......~..~/.~ .~..~......~..u..L~...~.....~....^ddress ..~.F...~E.~..~..~...(~.. .............. Phone No4ZT/[~..7.....~...~.~..O Name of Contractor ~£.C:..~Lq. lL~.....~J,~../L~li.E~.~....Address ...~).~..~/.¢..r...~.e..)..~.. ............. Phone No./~.7..:..~.....z/~.~). PLOT DIAGRAM , all set-b~ck dimensions from and street names and indicate STATE OF NIc-W YORK, ~ S S COUNTY OF ................................ .f · · ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Nome of individual signing application) 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 meke and file this application; that all statements contcfirled in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannbl"set forth in the applicg)ieln filed therewith. Sworn to be~ore me this / / _ /"so ff '' MARION A REGENT f I NOTARY PUBLIC, S~ate of New York kJ No. 52-3233120 Sufi'olk County Tile1 Expires March 30, 19.~ BERGEN AVENUE NOTE: · · MONUMENT. SURVEY FOR TERESA PELIS MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE: 1"'-40' APRIL 16, 1968 APRIL 16, 1968 I. AND SURVEYOR N.Y.S. I. IC. NO. ~8725. RI VERHEA D, N.Y. .r/