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Home My WebLink About3892-zTOWN OF SOUTFIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE: OF OCCUPANCY THIS CERTIFIES that the building located at ~./.~...~.~..~t~J,~,.~,V.~/iG.~ ................. Street Map No ....................... Block No ....................... Lot No.....¥~t~,~tlC~,....~;L..~'~ .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................... .~,~....:~..0.~ .......... , 19..~.0... pursuant to Which Building Permit No. dated .............~..~.....2..0.., .............. , 19~..i~ ..... was issued, and conforms to all al: the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ..... .e.~ ~.$..n.g...i?..o..o.L..(.~ .c..c..e..e..~ .o...z.y....~ .t..~.~.c.~..u..r..e..) ............. :. .......................................................... The certificate is issued to .....P...O.~.$.~..~....~..~..q~..~.t~,~,e.~/,~,:~',,,[,q~,l~L~.~.) ................................. (owner, lessee or tenant) of the aforesa'id building. FORM ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3892 Z Permission is hereby granted to: to at premises located at ...... ~.~......~..~i~O~[.,.~,?g~. ........... i ......................................................... pursuon¢ to opplication d~ted ....................... ~. ...... ~ ...~:.., ]9~}.., and appro¥c~t by the Building Inspector. 'Fee $.-~.?.~. ............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined x~(~) · .............. Approved ........................................ , Disapproved a/¢ ........ APPLICATION FOR BUILDING PERMIT Bt, ............................. .......... ......... ..... 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 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 with all applicable laws, ordinances, building code, housing code, and regulations. ~ ~ Doris Butterworth ~ ~ / (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. OWzler Name of owner of premises Doris & Jack Butterworth 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.: ........................ Street and Number N/S New Suffoolk Ave Mattituck Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....cl;..w...e.~..1.~ ............................................................................................................ b. Intended use and occupancy same with accessory bldg - above grounsl pool 3. Nature of work (check which applicable): New Building .................. Addition ............... ~.. Alteration .................. Repair .................. Removal .................. DemOlition .................. Other Work (Describe) ........ .S.~..I..D.I~...P.0. O...].. 4. Estimated Cost .,~...1.~)...,~..0..0, .......................................... Fee ..... ~. .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~lq~ .............. Number of dwelling units on each floor ............................ If garage, number of oars ......................................................................................... ; ........... ; ....................................... 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 ....... 2,~ ................ Depth ...... .1.6 ............. Height .................... Number of Stories ..... O~t .......................................................................................................... 9. Size of lot: Front ........ .'].OD ............ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..... ~.....~.~ .............................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation.;) ...... ~,Q ................................................. 13. Name of Owner of premises ...~....&:...~..~.~.~.~.~..3~T~...Q~.~dress ............ ~...~.~..~;~.~.~,1~ .......... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...~_?.?.....~...;~......]..Z3....C. .................... Address ..... .~.........~..o..¢...~..a..~.a..~. ............ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW' YORK. COUNTY OF ..h~.13~,,~13~,~. ............. ................................. .D...O..~..;i,.~....~..1A.~.~.;//~..(2~..~ ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ................ D~z3P,,Z ............................................................................................................................. (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 oil 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. Swam to before me this 20 day of ~.a..~. , 19 68 .................... zz Z ...: ........ ........... ;_ ........ J .............................. Notary Public, /.~(J~......~,...~._.~...C-~,~,~:k~._ County . (Signature of applicant) MARION A. REGENT NOTARY PUBLIC, State of New vor~ ~j No. 52-3233120 Suffolk Cou.y~_ 3'~a E.~rea torch 30,