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Home My WebLink About3843-zFOI~i~I N~O. 4 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. OEETIFIOATE OF OOP. UPANOY No. ~. 3.369. ... Date ....... D.~.~..~.~;r....1.7.4 ....... , 19.6.8.. THIS CERTIFIES that the building located at 855..I~Q~. t!t. tl:~.O~k..AV.~*. ..... Street Map No ............. Block No ............. Lot No..~tU~,. ~..~O~k ......... conforms substantially ~o the Applicati~on for Building Permit heretolo~e filed in this office dated .... l~tl... 11, ........ 19~8. p~rsuant to which Building Permit No. 3843..Z. dated ... tpl. tl .... ~ ........ 1968.., was issued, and conforms to all of the require- ments ,oi the applicable provisions of the law. The .occupancy ior which this ce~ificate is issued is p~lvate..one, i~ll~. ~ellt~. ~lth .g~aqe. la~c~ssory, bUild.g) The certificate is issued ~o ... ~a~O~d. RiO~ ........................................ (owner, lessee or tenant) of the afore.said building. / Suffolk County Department of Health Approval ..... ~[.] .((~ .......................... FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL coMpEETION OF: THE WORK AUTHORIZED) Permission is hereby granted to: ........ .................................................. pursuant to application dated...; ....................... ~ ......... .~ 19. .:, and approv~ by the g I SD ~t ~ r : ~ ~ r ~ ,?r;~Uitdin n e or,. Telephone: MA 9-8828 RAYMOND F. NINE -- RUBBISH REMOVAL -- P. O. Box 1194 NEW SUFFOLK AVENUE, MATTITUCK, N. Y. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. App, .on Disapproved a~ ................ .......... ................................. APPLICATION FOR BUILDING PERMIT Dat, .......................... .......... !..! ........ , .... 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. Raymond Nine (Signature of applicant, or name, if a corporation) ~ ~ ,~--% Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, ena. ineer, general contractor, electrician, plumber or builder. 0 ner Name of owner of premises ...~...~...~y~...°...~.d....~..Jr...~..e. ..................................................................................................................... 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.: ~ o ~ ........................................ L rna.: ........................ Street and Number ..... .~.5..5 .......... .~..~..~.....~..~..~.o...]:.~....~..v..e. ...................... ~.l..8:..t...t..:lr...t..~.?...~. ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.~.e..~.~.~.~ ......................................................................................................... b. Intended use and occupancy ........... ..~..~.~.e...)~.:Jr..~..~....~...r..~.?..~..e....g..~.?..~.g...e. ........................................................... 3. Nature of work (check which applicable): New Building .... ~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .............. 3.~.00~1...~. ............................ Fee .....1..0..:..0...0. .......................................................................... (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 cars ...... 2...CAT'. .................................................................................. ~: ....................................... 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 ..... 3.0 .......................... Rear ...... .3~ ................. Depth ..... .].0 .............. Height .................... Number of Stories ....Q~e ............................................................................................................ 9. Size of lot: Front ......... ..~..1.~.. ........... Rear .................................... Depth ...~..0..0..../...;~.1..~. ......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... t.t..~..'~...?.~.S...~. ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................. .~...O. ...................................... 13. Name of Owner of premises .~ ..~...o.~....~.;:k.~..e. .......... Address ............... .~.~.~.~,i,.~.13,.0.~ ...... Phone No...~....~..~.:'..~...~?.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... Locate clearly and distinctly all~ property lines. Give street and blocJ whether interior or corner lot. PLOT DIAGRAM whether existing or proposed, and indicate all set-back dimensions from number or description show street names and indicate % STATE OF NEW YORK. ~. c c COUNTY OF ...... ~.'g,~.q ],If; ......... ~ .... ....................................... ~.~g~.~....~.,~..~..e. ............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........................... ..0~'..,Tt.e...~....-....~..~..e.;~ .......................................................................................... (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 app!ication 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. to before me this ........ .................... ............ ..... · ~; - . ...................... .'... ~...~ .~.~. ~,,~ .......................... Notary Public, ...~..~ Count,v"'"~ ~'~;tu~r'~;f applicant) NOTARY PUBLIC, ~!~t~ cl G{ :, Yor/~ ConlmJssJon ~[xplres ~arc. 30,