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Home My WebLink About4006-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupnncy No.. Z .~[l~ .~-3 Date ............. 0g.~ .... ~. .... , 19.6.9. THIS CERTIFIES that the building located at ...E./.~....I~1..e.'~. ~ .l~.z.t.e.n..ti~{~eet Map No.. 'XX ........ Block No...~w ...... Lot No.. X~ ..... G.T.e.e.n.p.o.r.t.i..L:.I.: t..~...~, conforms substantially to the Application for Building Pemit heretofore filed in this office dated ........ Aug - · 2.~ ..... , 19.. 68 pursuant to which Building Pemit No...~006..Z. dated ......... e,~lg .... 23 .... , 19.6~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. ~riva.%e. one. family, cl~eiZ.~-g ..................................... The certificate is issued to .. 14i. chael .l~as.tm. os~o~e ...... .0Kn. e..r .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Underwriters ~ 1~76696~ House # 1000 FOlt~l NO. ~ TO~VN 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? 006 Z Permission is hereby granted roi ........ ,155....~.era.. ~!~ a .............................. ............. ~lJO. tal~lla ......... I~,X~ ....................... to ...~,l,~..ae~...om~.. J~mmL~..d~l.:Lt~ ................................................................................ ~ I et La ~t~..~ .............. at premises located at ................. ~ ....... ~ ................................................................... ............................. II~Jmlpor. t,..~l.Zo ............................................................................................... pursucn¢ to application dated ........................ ~ ......... JJ~ .............. , 19...~ and approved by the Building Inspector. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT TO WHOM IT MAY CONCERN: The sewage Date Bldg. OF HEALTH disposal facilities for a structure located (Give deed location) GFe~nport, Southold have been inspected by this department and found to be satisfactory. Owner Dr. M. Mastrosimome R~il~er-Edward Smith D~strict Engineer District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. Approved t.~ 19...?.... Permit No. ~'~r O (~ (~ ~ Disapproved o/c ...~ ............. ' ' .... (Bul)~;) ..................... 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 praPerty 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 iVb~DE 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 demoli~tjefl?, as herein described. The applicant agrees to comply with all applicable laws, ordinances, ildin code, . using e, and regulations. ' ]Signature of ~pplicant,~or name, if a corporation) CAddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .../..~..../...~.L~..~.~......../..~..~...~..~../.'.~.~.~.../~.~..../.~t.~/. .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: .., .................... Str~. and Number ......... './......: ........... ~.......~..,~x'.~./-Z~..~... ..........z~.../~,,~,~ .................................................. /o 0 u., pa,ty State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ........... .~../~,...~'...../}....~..../. ...... ...~....~..Z .......................................................................... ' / 3. Nature of work (check which applicable): New Building ........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... .~.~.~ ......................................... ee .......................................................................................... (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 ~E~) . 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 ~f Stories ........ .~.... ................. 8. Dimensions of entire new construction: Front ........... ~.&~., ...........Rear ........ ..~...~..'~... ....... Depth .,..~.~.,.~'...~... ......... Height ......1.~..~..~.... Number of Stories .................... ~.,~..~.. ..................................... v ............................................... 9. Size of lot: Front ........../.~ .........Rear ............... ./.~.~.. .......... Depth .......... ~..~. ......... 10. Date of Purchase ........ ~.~...,..../~.~-...~.. ........................ Nome of Former Owner .......... ~.~...~.......~.. ..................... .. 11. Zone or use district in which premises are situated ........... ~.....,~../.~,~..,,,3~... ........................................................... Does proposed construction violate any zoning law, ordinance or regular, ion? ................ /~/'~... ................................... 1:2. , ,, 13. Name of Owner of premises/.~/~.~,~.~Y..$../.~'..~...~.~Address~./~/.~.~ ....... Phone No.~../../.....~..~ Name of Architect ...................................................... Address ......................... £ .............. ~... Phone No ..................... . Nome of Contractor ........ ..~...~;.~.~..~....~¥. ................... Address~..~. Phone mo~7~; ......... PLOT DIAGRAM Locate clearly and distinctly oll 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. "' STATE OF S.S. COUNTY · ?,z_,,..~,~ sworn, says that he is the applicant (I 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 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. Swam to before me this ,~, . ~' ~~/ /// b "1 jl ;I ,,/