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Home My WebLink About5007-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. ~1~!8~ ...... Date ........... ~l~r!~... ~ .... , 19.75. THIS CERTIFIES that the building located at . .BlusOl B~M ........... Street Map No. I~tto. grot. Block No ........... Lot No...2([ & .p~r~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 0or...1.9 ...... , 19. ~ pursuant to which Building Permit No.. ~00~. dated ......... 0. e~; .....~...., 19~.0., 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 ..... Pl,'~,',~&l;o..one. fa~l~., rivalling ................................... The certificate is issued to ... tt.Bar. I~y. A~®e ......... (h~ner ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Heu.e # ~00 ( Building Inspector TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 5007 Z Dote ........... i- ......... Permission is hereby granted to: ........... ....................... J~.~. ~,~a~ ................. ! ................. to ........... jta~L.,~. · ~1~ ..a~ta~t, tea.. ~ · .ear,~L~tJ t~ - ~'~1 l~al~ ........... · ....................................... at premises located at ~,~. ...................................................... m~.~i...,..'..::t~.~.,.. ....................................... pursuan,t to application dated ......................... r ....... ~''';'''''j~'''~'''', 19..,.~ and approved by the Building Inspector. tee ~..~.e. ............ FOBM NO. I I~3~VN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved .............. ~. ......." , 19 ........ Permit No ..................... 'OO Application No ........................ , Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT Date ................................ .0...q ~ ........ .1.(:2 ......... , 19..2.0. ..... INSTRUCTIONS This application must be completely filled in by typewriter or in ink und submitted irt duplicate to the Building~ a. Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pu. blic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which Is part of th.e 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 Jn part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. h APPLICATION IS HEREBY MADE to the Building Department for t · 'ssua ce o a Buld ng Pem p r~ a Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other pppllcoble Law~, Ordinances or Regulations for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) ............ l~r~t2~clc ............................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ ~n.t~.~.c.t ~. ......................................................................................................................... Name of owner of premises ..... ..~..:....~...~..~..z'.~...A...~..e...c. ..................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) Location of land on which proposed work will be done. Map No.: .......... ~T~,~..~...~..~..I~..~..~.~.~.. Lot No.: ...... .2.6...~...~...x.~: Street and Number ..... ,~Lc~fi~.Q~..~ ........... ~,.'G~;.L1;LLg,]~ ................................................................................. '~'~f- ~00 -~' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..d~.e'l]izl§ .............................................................................................................. b. Intended use and occur:an? . ...... ~.~]~9...~r.J,.~ ....... ~(~,.~,QD, ....................................................................... 3. Nature of wink (chock which applicable): New Building ................. Addition ....~ ...... Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................. 4. Estimated Cost ............. ~D. O0. .................................. Fee ...~,.0.0 ......................................................................... (to be paid on fi'Jng this application) 5. If dwelllng, number of dwelling umts ...o..n._e ................... Number 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, jf any: Fron!'. ........................... 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: Front ............ ]..br.....~...1.Q ..... Rear ............................ Depth ..~.0...~...~,. .... Height .................... Number of Stories ...... 9.Tt~ .................................................................................. 9. Size of lot: Front ........................... Rear ................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... · "~" ~i~ ! 1 Zone or use district in which premises are situated .............. ~.k .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~O ................................... 13. Name of Owner of premises .~&r.Ey..,~,lf~ ............... Address ............ ,~.~.~ ................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor .~........~..b..~.~...~. ............................... Address ...... ..~c~....~.~. ............................. Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fram properb/ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. See attached survey etc STATE OF NEW YORK, COUNTY OF ...... .q~f~lk ........ J' 'a' ............................................... ~;.~....A..~.~.~.~ ............................ being duly sworn, deposes and says thot he is the applicant (Name of individual signing application) above n~med. He is the contractor (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and bel of; and tha~ the work will be performed in the manner set fo~h in the application fil~ therewith. Swam to before me this ' .................. of .......... ................. . Notae, Public, ~~[..~. Counh, ~~~nature of app~ ~LIZABETH 2~ .% NEW SUFFOLK VENUE SURVEY FOR HENRY BARRY ALEC AT MATTI TUCK 'TOWN OF SOU:'rHOLD SUFFOLK COUNTY, N.Y. SCALE: I"= OCT. 12., 1970 REFERENCE MATTITUCK ESTATES, INC. FILED SEPT. 8,1S LAND SURVEYOR N.Y.S.I. IC. NO. E8725 RIVERHEAD N.Y.