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Home My WebLink About3615-zI~OBM ~0. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWi~ CLERK'S OFFICE SOUTHOLD, N. Y. ~I~TIFII~ATI~ ISIF riDI~U~AN~¥ No .... Z -996' · ' Date ............ F~b ..... 29 ....... , 1968' THIS CERTIFIES that the building located at . .]~. t~4)&~[..(~i&J.1Olr, it,0.~W,Street Map No .... :K~ ...... Block No...XX ........ Lot No...X~.. ........ .M.a..~.~.~.~.'.ll.qk. 1. conforms substantially to the Applieati. on for Building Permit heretof, o.re filed in this office dated .......... ~O~'*t .... ;1.$ ..., 19.6~ pursuant to which Building Permit No.. dated .......... ~lapt;...~'l ...... 19.~F., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is .. Pl~i~ate..ona .fa~:LZy. d~-,/t&:tng ................................... The certificate is issued to ...t~i~a~B. '~'iel' ........ of the afore.said building. .Suffolk County Department of Health Approval .. .Fob...2~...~958 ................... 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) lq,° 3615 Z Date ......................... J~J).t~llJ)~.~.....~,~ 19....~.7 Permission is hereby gronted to: · J~-...~.k;L:~...& ..~'~-..:~.....~/.C.. ]l~,l,.. J~ AeJ' .................... ~l~,'~.~i;~,-~k ...................................... at premises located at ............................ )l~t.~J.%)~k)..l~,X, ............................................................................................... pursuon* to application dated ............................. ~p:l;..,.,J~ ........... , 19~1'.,., ond approved by the Building Inspector. ~Fee $.,,1~,,..q,~0 ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. 5 '7/ ~ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure (~ive deed-~oca~io~) / located have been inspected by this department and found to be satisfactory. District Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~../..! ........... ,1 Approved ........................................ , 19.....¢... Permit No....~.....?.../....?,....~ Disapproved a~ .............. ......................... ................................ APPLICATION FOR BUILDING PERMIT Application No..~.,..,~...,/.....~. ............ Date ............................... ~.~.~.~..... ~ .......... , 19.~,7 ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submi(ted 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 shah hove been granted by the Building ~nspector. 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. A. ReJlly. &: So~s. (Signature of applicant, or name, if o corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. .................................................. .C..o..n..t., .r..~,o.'~. p..r.....A....~.~ ,e..n..t.....q ~....q.~:.m_. p..r. .............................................................................. Name of owner of premises ...~.g, fL.~fl:V. ...................................................................................................................... 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.: ........ .~...°..~.~..~...?...°.~L~.~.,. Lot No.: ........................ Street and Number ...... .~..~..,~.,~.,~.z....~.~.:..0,...~.......~...~.~..~,.e.~..~.~.o...~. .......... ~!.~.~.~.o..~.. ................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy dwel].in.~ b. Intended use and occupancy ..... ~`.e..~...~..~..e.~.e...~.~.~`..~.~..~.~..~.d.~.e..~.:]~`~.z~..~.`~.~.e.~g~.8.~.g.~.~.~..~.~g~.~g~ 3. Nat,'ure of work (check which applicable): New Building ..~...~..X.~ ..... Addition .................. Alteration ............. Repbir .................. Removal .................. Demolition .................. Other Work (Describe) ' B?. ooo zo 4. EstJ~nated Cost ......~ .................................................... Fee ..................................................................................... (to be paid on filing this application) ,5. If cjwelling, number of dwelling units .....o.b.e. ................. Number of dwelling units on each floor ....................... / If g~aroge, number of cars ...................................................................................................................................... 6. If ,business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~n~ens~ons of ex~st~ng structures, if any: Front ............................ Rear ................................ Depth .................. Height ........................ Number of Stories ............................................................................................................ DiMensions of same structure with alterations or additions: Front .................................... Rear ....................... Derjth ................................ Height ............................ Numbfr of Stories ................................ 8. DiMensions of entire new construction: Front ............. ..~..2. ........ .8. ........ Rear ....... .6. ~. . .-. .8. ............ Depth .~.~. ............. Heibht .................... Number of Stories ....... .O...~..e. .................................................................................................. I ~. [FO + 9. Siz~ of lot: Front ......... ]..O.~. ............ Rear ....... 2.0. f~ ...................... Depth .......... ~.. ................... D tlo Purchase 19.6~. Name of Fnrm~r Owner Gottschieus (sp ?) 10. ae f ..................................................................................................................... I l. Zor}e or us~ district in which premises are situated .......... A.....d2.S.t; ..................................................................... 12. Doe's proposed construction violate any zoning law, ordinance or regulation? .......... ~D ........................................ 13. Na~ne oF Owner of premises ~.~...~..s....~..e..$.e..~ ............. Address ....... ~.~.~J;.$.¢.~.0.~ ............... Phone No Na~e of Architect ...................................................... Address ............................................ Phone No ................ PLOT DIAGRAM I_ocat dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f property ~ nes. Give street and block number or description according to deed, and show street names and Jndi~ whether in :erior or corner lot. ~'~ ~ /~ ~-, STATE OF NEW ,Y, OI~K. COUNTY j OF: .....~ ,~., ._L],];'. ,D,: ,L~ .......... j Norman. I~eillly. being duly sworn, deposes and says that he is the applk ................ ................. above nar~ed. He is the ...................................... ~l>.B."C.T.a.¢J/,.C.'r' ............ (Contractor, agent, corporate officer, etc.) o{ said owner or owners, and is duly authorized to perform or have performed the said work and to make and this app[icat~an~ that all statements contained in this application ore true to the best of his knowledge and belief; that the ~,ork will be performed in the manner set forth in the application filed therewith. Swam to I~efore me this .... .............. ..]~J,... day of ................... L Notary P~blic, . ........................................................... County j' (Signature of applicant) j