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Home My WebLink About4174-zFORM IgO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~ .351~ .... Date ....... ~..tm® .... 30, ......... , 196~1. THIS CERTIFIES that the building located at .Z/~. l~&,~'om~ .Roa5 ........ Street Map No. ll$~e~way.. Block No ........... Lot No. Matt~l~u~.k,. ~. :gori~ ......... cen£orms substantially to the Application for Building Permit heretofore filed in this offiee dated ....... ~...at~. nFy...2.~.~., 19 .~9. pursuant to which Building Permit No..4174. ~. dated ....... ~.~.~u~y...~2, o.., 19.69., was issued, and conforms to all of the require- ments of the applicable provisions o£ the law. The occupancy for which this certificate is issued is ... p;c.~,Va~:e..one..~em~d. ~b~e~,l~g ................................... The certifieate is issued to ...~eo~ge. BI&~:s ....................................... (owner, lessee or tenant) of the a~oresaid building. Suffolk County Department of Health Approval Building Inspector' FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4174 Z Permission is hereby granted to: ..................... Ml~tt:ttmmk .................................... to {~J. Z0...ame~t ..mme...fmm. S.2~.. x$'~m l12.ul: .................................................................................... at premises located at ...... ,~, .~.......~..~....a~......~,.,O~.. ......... ,.(,,M,~.....l?....l~,.....~...e~,.,~...e...). ..................... ................................ l~t,:t, IJl~ ...... ~.~[~. ........................................................................................ pursucm~' to application dated ............................... ~11~ ........ ~,.~ ........ , 19.,.~., and approved by the Building Inspector. Fee $ .{.~.~.'~..~). ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. P TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at (Give aced location; ~/ ~ have been inspected by this department and found to be satisfactory. JIJN 2 7 ?§69 District Engineer District Engineer Examinec~../ ................. , .. Approved .................... ,19 .... Permit No. ~/.. ?..~. ~ Application No ................. (Building Inspector) / APPLICATION FOR BUILDING FERMIT Date ................. ~.~.~..~t...x~...~.1... 19. ~.9 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec~r. b. PI~ plan showing location of lot and of buildings on premises, relationship to adjoining premise~ or public streets or area~ and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatkm. c. The work covered by this application may n.ot 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 prngre~ of the work. e. No building shall be occupied or used in whole o~ in part tk)r any purpose whatever until a Certificate o~ Occupancy shall have been granted by the Building Inspeclx~. APPLICATION IS I-I:I~RY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold~ Suffolk Oounty, New York, and other applicable Law~, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable law~, ordinances, building code, honsing code, and regulations. · ............................. (Signature of .agplicant, or, name ff a corporation) M.atti tu~k- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .......................... ~DJ~I;~.~¢.~Q~' ............................................................ Name of owner of premises 6eo B~.a.~.~. ..................................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location .of land on which proposed work will be done. Map No..~[~.~$Ke, y ..... Lot No.. 0.~1;).,~, ,... Mattituck Street and Number.....E~S.. ..........Racoon .R.o. $.d. .... .............................................. .. .... fi/ _ ~,~ %~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ...... .v. acaxxt. Jan& ............................................... b. Intended use and occupancy ........... ora .$ami:].~r..Glwolt.~g ................................ 3. Nature of work (check which applicable): New Building ....;jr,~.... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ~. ~ 00.O,~ ............. ~...~ :,...i. Fee ... ~ Q...~ ........................................ · · . . . (to be paid on filing this application) 5. If ,dwelling, number of dwelling units . Ola~..Z ,...Nu'mber of dwelling units on each floor .............. If garage, number of cars .......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, ff any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories .............. ' ..................................... ~ .... Dimensions ,of same structdre with alterations or additions: Front .............. Rear ...... ..., ..... Depth ................ Height ................ Number of Stories ..................... 8. Dimensions of entire new construction: Front ....... .~0~ .... Rear ...~..(~.~ ...... Depth ...~9.-..6... Height ............ Number of Stories ............................................................. 9. Size of lot: Front . .12.~ ......... Rear ...... ~P~.~ ~.. Depth ... :1.~1+/..~l~.~. 10. Date of Purchase ..... .~.c)6~q .................... Name of Former Owner ...]~er. Zgr~berg ............ 11. Zone or use district in which premises are si.t~ .a~ted. ~..i. '."'A~' .~ClXa~' ~'; ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ l~O ................ 13. Name of Owner.of premisesl~eo. ]~&l;Z .......... ~ddress . ]~Vd.. Lau~.e~ ..... Phone No ............ Name of Architect ............................. -~ddress ...................... Pltone No ............ Name of Contractor . A.. Rei3A,y. &. ~ ........ Address ..... l~Iat.~ltuck ..... 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 de seription ac~rding to deed, and show street narfies and indicate whether interior ~0r corner iot. ' · l{o~qa~n, lt~tll~ .................. being duly sworn, deposes and says that he is the appli. (Name of individual signing application) can.t a.hoye named. He is.the ........ Col~ra~¢o~ .... : ..... ................... ,--. ..................... (O0~traetor, agent, corporate office~,; 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 centained in th is application axe true to the best of his knowledge and belief; .anal that the work will be perfiaemed in the mann er set fortl~ in the application filed therewith. Sworn to before me this .......... dayof .... zff/7 ' · .. ..... ............... ..%: