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Home My WebLink About3428-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BERTIFIBATE BF BBBUPANBY 29O7 No. 2~ ~ Date .. O~tobex' 20, 19 THIS CERTIF ~I~S that the building located at E/S CemI~ Ml~eola .Road Street Map No. ~ 'Block No ~ .Lot No. ~ ~tti~lck¥ 'N ;~ ...... conforms substantiall~ to the Application for Building Permh heretofore flied in this office dated -April I0, 19 6g pursuant to which Building Permit No. 3~28 dated April 10 , 19. ~7, was issued, and conforms to all of the require- ments of the applicable provmions of the law. The occupancy for which this certificate issued is Priva~ one..fa~.ly, d~ell~ ................................... The certificate is issued to . ~s W~lltam ~bb~m~ ....... ~2 .............. (owner, lessee or tenant) of the aforesaid b~lding. Suffolk County Department o~ Health Approval . N~Re ........................ FOP,~I 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? 3~28 Z Permission is hereby gronted to: ............ ~......~..~.,~.........i~..~ .......... ......... ~tt~t~kr.I.Z. .................................. to II~1~.. a~. J~bLtttm~ .&..~im..~l:l~z~t~n~ .. ~.. ~. ~z:L~..~tmLM~ ......... at premises located at .,..~.........~..~..~...-...~... .......................................................................... ............................................... il~e.t.t;~,~,..... ~. ,...3~, ........................................................................ pursuan¢ to application dated .............................. ~J~'~.....-~O ......., 19~1..., end approved by the Building Inspector. GARY FI~NNER Olsen COUNSELLOR AT LAW BLDG DEPT TOWN__OF SOUTHOLD P 0 BOX 706- main ROAD · CUTCHOGUE, LONG iSLAND. NEW YORK li935 m PHONE 5~734-7666 FAX 5i6-734~77I~ Nay 25, 1989 Re: Matilda Haberman SCTM No. 1000-123-6-8.1 2505 Camp Mineola Road, Mat%ltuck, NY 11952 Gentlemen: Enclosed please find a check in the sum of $10.00 for ~'~oi: Certificate oi= Occupancy in connection with Building Permit numbe~3428~ ~FO: lmk Inclosure Sou%hold Town Building Dept. Main Road Southold, NY 11971 FOI~M N~. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................................... ~..., ] 9 ........ Permff No .............................. D~s~roved a/c ....~ .................. ~.. Application No. APPLICATION FOR BUILDING PERMIT Date .................... :!..J ..................... , ..... INSTRUCTIONS o Th~s apphcat~on must be completely filled m by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showmg location of lot and of buddmgs on premises, relationship to adjommg premises or public streets areas, and g~wng a detailed descnpt~on of layout of propertymust be drawn on the d~agram which is part of this applicatior c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant Suc permit shall be kept on the premises avadable 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 Occupanc shall have been granted by the Buddmg Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th Budding Zone Ordnance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, ad&tions or alterations, or for removal or demolition, as herein describec The opphcont agrees to comply with all applicable laws, ordnances, building code_ ,end regulohons. (Signature of 6pplicant, or name, if a corporation) Camp Mineola Road .. ~t~tt~uck,.. L~g..Ia].~ud,...~{ ^..~.~ ................................... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildei 0~mer Name of owner of premises ...~...~LLll~ ~-a..g,...~he. rm~m~ ............................................................................................. If applicant ~s 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' . ...........................................Lot No' . ................ Street and Number C~emp.~oJ_e..~c~ad,..~t,~,it,~zc~k.>..g.,..7.. ................................................................................ Mumc~pality 2. State exmtmg use and occupancy of premises and mtended use and occupancy of proposed construction: a. Existing use and occupancy ............ Ree:Ldent, ieJ. ............................................................................................... b Intended use and occupancy ........ Rftl~:L~ft~.~.e,~, ............................................................................................... 3 Nature of work (check which applicable): New Building .................. Addition ...x~ ....... Alteration ................ Repair .................... Removal .................... Demolit~o ~'i-'~' .........Other Work (Describe) .................................... 4. Estimated Cost ...... $~.~00..00 .................................... Fee ........................................................................................ {to be pa~d on filing this apphcat~on) 5 If dwelling, number of dwelling units ~. ......................... Number of dwelling units on each floor ..~,. ..................... If garage, number of cars .......... 1 ............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mensions of exmsting structures, if any: Front ~! .................... Rear ......... 32,! ........... Depth (.2...8.! .................... 1 1/ (Y+O' Garage Height ....... ,l.$.: ............... Number of Stories ............ ~'2 ............................................................................................ Dlmenszons of same structure w~th alterations or aad t'ons Front ...... 4/+:. .................... Rear /'/"~ Depth :~.$.':./+.O.."...g.a...r.a.E,e. .... Height ........ ~,¢ .................. Number of Storlesl..../. .................................. 8 Dimensions of entire new construction Front ...... 12.! ................ Rear ......... 3,24 ............. Depth .....1.?. ................ Height ...,1,/+~ ................... Number of Stones Z. ......................... 9. S~ze of lot: Front ....l~G! ................. Rear ........ .1.00:. ............ Depth -74,9: ....................... 10 Date of Purchase ....... J. uly.. 1.1_ ,...1.9/+6 ..................... Name of Former CM, ner .... DeF. oz'es.t..Ho.r.ton. ................... 11. Zone or use district ~n which premises are s~tuated ............................................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation? .......... ~1'~ ...................................... 13. Name of Owner of premises ~[a.t:bl-da.~abe~;m~ ...... Address ..~a~,f, it, uck~..A,..~r .......... Phone No. Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ........ Quak~'..Ridge..Bldz'a ........ Address ~.7.. ~-c~uehaga. e.~..A~..~ ....Phone No~A...Tm0.0.93. t,~.~,~'L,-~..u, owski PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex,sting or proposed, and indicate all set-back dimensions fro property hnes. Gwe street and block numbers or description according to deed, and show street names and ,ndica whether ,nterior or corner lot. STATE OF NEW,/¥OP~K,, COUNTY OF ~...r-~.m~....,K.~:~. }SS. Matilda Haber~s~ be ne duly sworn, deposes and says that~e is the applic (Name of indwiduo signing app cat on) above namedSHe is the .................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa,d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s apphcohon, that oil statements contained ,n this application ore true to the best of his knowledge and bel and that the work w~ll be performed in the manner set forth m the applicahon filed therewith. Sworn to before me this .............. ~.., .... day of ..~~.~. ........... , i~orary vuouc~c,~....'~.~~~nry ~, ~,gnature at appucan~ Comm~smon g~plr~ ~r~h ~0, 19~ /~/ /