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Home My WebLink About3567-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, BERTIFIP, ATE DF FIEIE:UPANP, Y No. Z 29.1!.3 ..... Date ............ l~oveq~be:~. ,29,,., 19.67. TttlS CERTIFIES that the building located at .. Blossom. Bend ........... Street Map ~o~a~.tltU~.k ~l~o~os. ............ Lot No. 33 ...... ,~.a.t..t.i~:.~e..k,..~,.~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Aug ..... 1t3 , 19.6:7 pursuant to which Building Permit No. 3[.6.7. dated ........ All§, ....10..., 1967.., 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.l~lva.t.a .one..fairly. libelling ...................................... The certificate is issued to .l~l~.t.t.:~.t.ll.qk..E.~.t.~.t~O~..~0 .......... 0~rla,~l~ .............. (owner, lessee or tenanO of the aforesaid building. Suffolk County Department of Health Approval N.o.V.,..2..~. ~.9.6.~...by..~.l.~..~:i..l~.a, .... I Buildin~ InspecTr FOI~M NO. ~ TOWN 01: $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE sOuTNOLD, N. Y. .BUILDING PE~,J~IT (THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL · COMPLETION OF THE WORK AUTHORIZED) '3567 Z Permission is hereby gronted to: ............ :..~..,i,.~:..~.~t~.... -~~ ............... ............... L~.~t~.....i'.i:.~ ............................... t~ .~.._~...~...~....:~..., ~.....~ .............................................................................. ~t premises Iocoted ot .,~t~.~ .............................................................. ........... ~.....~ ...... :.....~,,~.~,..'.....~~ ..................................................................... pu(s~anrc to apl~lication date~J-~.,'.,.,..;.....~ ....... ~ ......... ~.~j~....~ ....... , 1~.~..., and approved by the Building ,' Inspector. Fee $ . S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH NOV 22 1§67 Da.te Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located location)' (Give de&'d have been inspected by this department and found to be satisfactory. District Engineer FOI~M NO, 1 TOWN OF SOUTHOLD BU~ILDING DEPARTMENT TOWN CLERK'S OFFIC£ SOUTHOLD, N. Y. ....... , Approved ........................................ , ]9 ........ Permit No. ~. ....................... Disapproved a~~~~.~ Application No ............................ APPLICATION FOR BUILDING PERMIT Date .............................. ....... ....... m...6..2. ..... 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 and regulations. Mattituck Estates Inc (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) Stc~te whether appl,icant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Owner - builder Mattituck Estates Inc Name of owner of pre_raises .................................................................................................................................................... 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. Mop No.: ..~a.t.~:~L1,¢~..,~.t,.,.... Lot No.: ..... ~.8. .............. Street and Number Blossom Bend Mattit~¢k Municipality 2, State existing use an~ occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~&o~D¢ b. Intended use and occupancy o~e i~amily dwelling 3. Naliure of work (check which applicable): New Building XXX Addition Alteration Rep~air .................. Removal .................. Demolition .................. Other Work (Describe) EstiL, ate~ r-ost 16~000 ,. 10.00 4. I" u ,~ ........................................................... tee , (to be paid on filing this application) / 5. If 4welling, number of dwelling units .....O...~.~ ................. Number of dwelling units on each floor If g'.arage, number of cars one 6. If Ipusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. D~ens~ons of ex~st~ng structures, if any: Front ............................ Rear ................................ Depth Heibht ........................ Number of Stories Ditensions of same structure with alterations or additions: Front .................................... Rear Del~th ................................ Height ............................ Number of Stories ................................ ' ............ .6..0. .................... Rear .......... ,6.Q .............. 26 8. Dir~ensions of entire new construction: Front Depth Height .................... Number of Stories ................. .o..~ .......... 9. Siz~ of lot: Front ............................ Rear .................................... Depth ................................ 10. Do1 of Purchase ........................................................ Name of Former Owner 11,. Zor or use district in which premises are situated "A" dist 12. Do~ proposed construction violate any zoning law, ordinance or regulation? no . Mattituck Estates .Inc Mattituc 13. Nalne of Owner aT premises ........................................ f',ddress ............................................ Phone No. No'ne of Architect ...................................................... Address ............................................ Phone No, Name of Contractor .................%0,.~...e. .......................... Address ............................................ Phone No. ', PLOT DIAGRAM L t~ I n ~st d t oca c early a d d' inctly all bu' dings, whe her existing or proposed and indicate all set-back dimensions property l~nes. Give street and Neck number or description according to deed, and show street names and whether in[terior or corner lot. STATE Of COUNTY above nar of said o~ this appli~ ) .......................... ~d.V..*..,~.~.g. .............................. being duly sworn, deposes and says that he is the applic (Name of individual signing application) ~ed. He is the ....................... ~..o.~p...p~:,~.3.qer (Contractor, agent, corporate officer, etc.) 'her or owners, and is duly authorized to perform or have performed the said work and to make and ation; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ ~rk will be performed in the manner set forth in the )lication ~rewith. Sworn to ~ efore me this Notary Public, . ~ aunty (Sig~ e of ant) .J son ,~:xp~res March 30. 19..~