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Home My WebLink About4455-zFORM NO. & TOWN OF SOUTHOLD BUH,IHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..$..3~.~7 .... Date ......... o'lme ...... 3, ...... , 1970. THIS CERTIFIES that the building located at .M/~. ~. S.U£fOlk .&~nu~. Street Map No. ~XXXX ..... Block No..~...Lot No...~tt~.tuak, .1~ .~k ........ conforms substantially to the Application for Building Permit heretofore filed in this office ~dated ...~.eP.t...~.. ~ .... .9)..., 19, .6.~. pursuant to which Building Permit No: .445~ .~ dated .80P.t...el~.. R .... .~ ...., 196.~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is iSsued is ...... p~..l.v..a.~....~..e..~...m~L..1.¥...~. !.~.g .................................. The certificate is issued to ...... .i~...~.eF. T.-...1~..1..~. ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ .St..],~?O~..R~I~.F$!!.~ ..... ............ HouIo # 2055 b fln£folX Avenue POEM NO, ~ TOWN OF $OUTHOLD 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? 4~55 Z Permission is hereby granted to: z:o ,~c~ z. ~.. ...... ~./~.~../~.£..~: .......... ~ ....... A.~.t..7.Z... ................................ .~...~: ~...~.'..~..-. .......... ~.V.~.~... ............................................. ~,~...-r~..~...~..~C.,<~ to ................. ~.~.~..b .............. A/.~..l~. ......... ~,-._~ ........... #~.~,s./.~...y .......... .~.~,~t~.~.~.. ~.~.G.~ 02~_~ , ~t~ - at promises I~ated at ............. ~ .............................. .~.~ ............. ~.~.~ ........ ~.~.. ........................................................................................................ ......... pursu~ to application dat~ ................................. 'e'"",'~:~" 19....,.~d appr~ by the / Building Ins~ctor. APPLICATION FOR BUILDING FERMrT INSTRUCI'IONS a. This applica;~ion must be completely filled in by t~/pewriter or in ink and submitted in duplicate to the Building Inspector. b. Pl.ot .pi.an sho.w, ing I~ior~. of lot a.nd of bu.ildlags on prem..INs, relationship to adjoining promises or public streets or areas, aha g~vlng a ama,ma aescnptlon of layout orprat~lrty mU~t be drown on the d agram which is part of this application. c. The work covered by this application may no4' be commenced before issuance of Building Permit. d. UpeG:PPpmvGJ of.this application, the Building Impector will Issue a Building Permit to the applicant. Such permit shall be kept on the promises 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 Impector. i~ .A.P..PLI~CATIO~N .!S HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the u,a~n.g. :one. ur.mnance of the Town of Southold, Suffolk Count~_, New York, and other applicable Laws, Ordinances or ~g~ulat?.ns, tot the construction of. buildings, additions or alterahons, or for removal or demolition, as herein described. T e apphcant agrees to comply w~th all applicable laws, ordinances, built housing code, arid regulations. (Signature of apphcant, or name, If ~Eorpo~atlon) (Address of ®plicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ..................................... Name of owner of promises ............................... .../~.. E..~...T'~...~...Z.....Z .... ~ ...~... ~ .................................................................. "r~ ...... . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~ ~ ~ ~. ,~i~. ~//~.,~/q ~]~/~ ~=at~ ~ ~ ~ . ~ ...................... ~,,o..,,.~...,.,.,. " ............ , ............. : ..................................................... '~;ia~ii~ ................................ ' .......... ............... ................... ~ ~ ~ ~c~ ....... ~ ....... , ............. ~ ........................ ~..;...;.~;..;; .............. ; ......................... ; ................ 3. Nature of work (check which applicable): New Bu Idi~g :~ ........ . ..... Addition .................. Alteration .................. Repair .................. Removal .................. ,Demolition. ................ ; OtJ'~e~Work (Describe) ........................................ 4. Estimated Cost ..................... ~-....~.. ; .~ . ; ~ . ............................................................... (to be paid on filing this application) -5. ~ !f' dwe!ling, number:o[<h~'elling units ............................ r~ moer of dwel!ing~units on eac~ .floor ..............; ............ ff garage, number of cars ........................ ~..../~.....Z..-..~. ...................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dirne~sions of existing structures, if any: Front .......~ .................... ' Rear ...................... : ......... Depth .................... Height ........................ Number of Stories .......................................................................... , ................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ............................... Height .,;........~,: ........... .Num~ber 9f Stories ............. ~,~.? ........... . ....................... 8. Dimensions of entire new cOnStruction: Front ....;...;.: ,.~....~... ........ Rear ........ ..-~....~./.. .......... Depth ~' '~ Height ...... ./....~.. ...... Number of Stories ................... ~...~..~,~. ..................................................................................... Size of lot: Front ........... ./...~...~ ........ Rear ......... ./.~....;~..'~.. ............. Depth .~.~...~....~....~...~.. Date of Purchase .............~.!./..~...7...~. ......... ../...0..~.~.....Name of ~o,~er, ~vner ........... ~ ............................................ Zone or use district in which premises are sifuated ........................ ~...~ ......................................................................... Does proposed construction violate any zoning law, ordinance or regulation? ............................... ~,.....~.~.~. Nome of Owner of premises ............................: ........ t.~am~s. ......... ~Tj.t~.~w.~,~,.~ ......... Phone No .........;.; ......... Name of ^rch~tect ......... ~;..~ ......... ~.~...L~...7=... ........ ^ddr,~ ............. , ........ ~.: ................... Ph~* No ..................... Nome of Contractor .................................................... AcJdress ............................................ Phone No ......... '; ........... 10. I1. 12. 13. PLOT DIAGRAM Locate clearly and distinctly a I buildings, whethe~ existing or p..mposed, and indicate all set-back dimensions from property lines; Give street and block number or descr pt!on according to deed, and ~ street names and indicate whether Interior or comer lot. ~ COUNTY~ ~ ,--,---O~ ,.'~..:.?....j~, · ' . ~ .... ........ : ........ ~..:::~....; ......................... :be,~ ~iy *,,om, ~ on~ (N~of indiVid~l~ni~l~i~ .: ~ .~ ;: ~ ;: ,. .,~ . . a~ve na~d. He is tbe ..........................~.,'. .............................................................................................. ...... ' (~t~m, ~t, c~ offi~r, ~.) of~id~neror~ne~, a~ is~lya~t~rz~t0~ or ~ ~ ~e ~jd ~ a~ ~ ~ ~ file this ~licafi~;' ~m all:'~ements c~ in ~s ~lic~i~ am t~ ~ ~ ~ of h~s ~ a~ ~lief; a~ that t~ ~rk will ~ ~ff~ in t~ ~n~r ~ f~h m the ~lic~i~ fll~ ~1~. ..... ....... ........... , Term ~plres ~rch 30. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date June ~ 1970 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at n/s New ~tffolk A~enue 200, e/o Reeve A~enue~ Mat%i%uck (Give deed location) have been inspected by this department and found to be satisfactory. Dlstr:Lot '~l~eez, District Engineer-~,.~