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Home My WebLink About3838-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .37.~J ...... Date ............. ~r~....~ ....... , 19..?0 THIS CERTIFIES that the building located at . .1~/~..t}e. ~p..H~..D:V ....... Street Map No.. X_X ........ Block No... Y4~ .... Lot No...F~X ..... ~laJ;t;lt.~\~k...1~.~. ~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Aprf~l ... JO , 19.6~ pursuant to which Building Permit No. dated ........... Ap~¢i]....J.0 , 19 ~8, 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 . P~iva.te. cna .fairly. dlceZ.ting ...................................... The certificate is issued to .. A.,t~,Val].ar~ ....... 0'~rta~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N Building Inspector~ House f~ 2080 FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU'I'HOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FUEL COMPLETION OF THE WORK AUTHORIZED) N? 3838 z Permission is hereby granted to: ~i~..~..~.~..~....~.~.'..,~m:,m~ ...... ~at~l.t=~ ......... :.....:: .......... : .............. ::. ...... at premises located at ....~JL...])~$.~]~tl..~.....Wg..~ ................. :...?..., .................. : ............................ ~.~l~am~ ................................ ~: ..... ) .............. :...:.....:..~....: ......... :., pursue( .tO application do'ed ............................. ~ ...... ~j$..;...., i9:.~, a~d aPPrOv~ by the : Bu!lding Inspector. ,Fee $..~.....~..;.; .......... Approved ........................................ , 19...4.~.. Permit No. Disapproved a/c ................... APPLICATION FOR BUILDING PERMIT April 10 68 Date ............................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Pot p an show ng 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 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 shell be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sholl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iS~qapce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yorl~me~q'~-'~apphc'~a~ble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demoh'tio~i~, ~as herein described. The applicant ogrees to comply with all applicable laws, ordinances, building code, .housing code, and regulations. Mattituek House Mov.qr (Signature of applicant, or name, if a corporation) Mattituck N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises ....~..t..~..:.?.?'...]:..]:.a...~'..O.. ...................................................................................................... i ............... 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 Nb.: .......~...T. ............ Street and Number ..... ..~./..S.......D...e..~.D...~g~.q....D.3;'.~..V.~. .............. ..N.P,.~..~,~LL(~ ........................................................... ..~/- ,~ o ff~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~W.~.~,,~.;~13~i ........................................................................................................ b. Intended use and occupancy ................. same...wi:l;h, an .adrli~i. oz~..&.JkL~,~ratLc~ ............................. 3. Nature of work (check which applicable): New Building .................. Addition .....~ ..... Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ *_. - .oo 4. Estimated Cost .................................................... ,ee .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ..o..~..e. .............. Number of dwelling units on each floor ............................ If garage, number of ca:rs ............................................................. ~ ....... : ...... :~ ................................ 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 ............ ~,0 ................... Rear ........ ~,0 ............... Depth ...2D ................ Height .................... Nymber of Stories .....o..~...e. ........................................................................................................... 9. Size of lot: Front ............................ LF0 Rear .................................... Depth ......~..~...~. .................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ r ' A dzst 11. Zone or use district in which premises a e s~tuated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ..~..O.. .......................................... 13. Name of Owner of premises .A....~.~,~,~.~:~g ................... Address ........~..~...~.~..~.~.1~..~.~.. ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor Mattituck House Move..rAddress Mattituck ................................................................................................ 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 ond indicate whether interior or corner lot. STATE OF NEW YORK. ~ S S COUNTY OF ..... ~..~Q~I~ .......... i · · .............................................. ~.e,l~l~...~.~,,l,~ .................... being duly sworn, deposes and says t~t he is the applicant (Name of individual signing application) above named. He is the .................................... C~=~Qr. ............................................................................................ ~Contractor, ag~t, corporate officer, etc.) of said owner or owners, and Js duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application' filed therewith. ................... of ..... ............. ............ , ~o ~ ublic,~..~..~...~.~.....~.~.. Coun~ (Signatu~applicant) NOTkRY P~LIC. St~e of New Yo ~o. 52-3233120 Suffolk ~0unty Te~m ~pir~ ~rch ~.