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Home My WebLink About3489-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI'CE SOUTHOLD, N. Y. I-:Et~TIFIP. ATE OF or':,I-:.UPANr, Y No.~t .2~3 ..... Date .............. ~$,~F...~.l~., 19..67 THIS CEI~TIFIES that thc building located at IIW. ~laffol.k · &~l~ .&. ~l~ell~- Map No... ~2,~.. Block No .... XX ....... Lot No. [t7 ...... ~attituek~... 1[.]~ ... conforms substantially to the Application for Building Permit heretofore filed in this office dated .~ ~T ..... 22 ........ , 19.6~. pursuant to which Building Permit No. dated ........ ~ .... 23 ...... , 19 67., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~vat~ .~/,~ .£'al~t;.v. 4~a] ',' ln~ ..................................... The certificate is issued to .~,.'&~$~C~s .Tot~ ....... 0~1' .................... (owner, lessee or tenant' of the aforesaid building. Suffolk County Department of Health Approval ...~[. '0Cl;' "3~' ~:~7' 'by' Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILmNG Z~E~ARTM£NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL ~.I~-q'IQN OF THE WORK AUTHORIZED) N? 3~89 Z Permission is hereby granted'to: ..~8~:.,T~J~..~....~ .................................. to ~::~.~ ...~.~...~.~...~.e.~.~.L..: ............. ~ ................................................................ ,,, puJ~suag¢,to.apphcatmn, dated ...... ;. ....................... ...~r .......... ~..~ 19,~.., and approval by the" Buddln~ ImpectorI SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: Date_ Au~ust 24~, ~967 Bldg. Permit No. 3489 Southhold ~ldg" ~ept. The sewage disposal facilities for a structur~ located at S/W~C, New S.,u.f,folk ~Avenue & Deep Hole Drive (Give deed location) Mattituok, LoIo, NoYo have been inspected by this Department and found to be satisfactory. Distri0t Engineer Distric't Engineer" FOI~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No................................. Disapproved a/c ............. :: .................. :.....:i ......... '..::%:......:::j ............................ '(Building I ns~:t'c~i ..... Application No..¢.?.../,~¢~.../... ......... APPLICATION FOR BUILDING PERMIT Date ...................... ........................... , 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 propertymust 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, bui~Jing~code or)~L regul,ations. / ........... .......... (Signature of applicant, or name, if a corporation) , ......................... ........................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ~:;~.,~,,~.~...~.,m~.'.~ ~..: ..................................................................................... .~ ...................... : .................................... _~ opplieent is a corporate, signature of duly~,outhodzed officer. ' ~ (Name(:,c~nd title of corporate officer) I. Location of land on which proposed work will be done. Map No: .....~'/..~....~..~ . Lot No: 4 '~ ' Street and Number ................................. ~ .............................................. .~,. ............... ~.*.~ ,~,~., ................... Municipality 2. Store existing use ond occupancy of premises and intended use and occuponcy of proposed construction: Existing use ond occuponcy ,~...~...~"~ , Intended use and occuponcy' i i i,~.'~i:i"i i~ ~ i : .~.' ~.~.' ~.' '~' ~i~.' ~ .~.'.' ~': '~'.~.' ~i :~ i~."i ' 'i .................. 3. Nature of work (check which applicable): New Building ..... ~ ....... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... (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 .......... ~,4~.~.~.,...; ........................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures~ if any: Front .....~x./~..~.~,,.~;... 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: Fronf ................. Rear ...~...~... ................ Depth .......~...: ............... 11. Zone or use district ]n which premises are situated....,~...: .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...,~...~...,; .................................... Name of Architect ...................................................... Address ............................................ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, '/, S.S. COUNTY OF ................................ ) ~Z-"'~'/-,~,~ ~ 5~. ben dui sworn de oses and sa s that he sthea I cont ........ ~ .............................. ~' i "~'";' ~'" ' .......... g Y P Y PP Lx~ (No. me of individual s,gn~ oppli~,ion)~ _ ~ (Contractor, 6dent, 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. Sworn to before me this ~ ~ ~' ....... .............. Noto~ Public ......... ~.A~.~o .............. County /7 (Signature of appear)