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Home My WebLink About4687-zFO~M NO. 4 TO~VN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~ ..... Date ............S®p~..8..., 19.~0. THIS CERTIFIES that the building located at ]~looSO~. IN~I. ~ .~ ~eet Map No.~t~,. [~$,. Block No ........... Lot No..~. ........~t~... ~.. confoms subst~ti~y to the Application for Buil~g Permit heretofore filed ~ t~ office dated ........~p~...l~.., 19..~ p~su~t to which B~lding Pemit No. ~.. dated ........... ~p~..~$., 19.~., was issued, ~d conforms to ~1 of the req~ men~ of the applicable provisions of the law. The occup~cy for w~ch this certificate is issu~ ~ ~$~. ~. f~. ~.~ ' The ce~fficate is ~su~ to . ~. ~... ~ .......................... (owner, lessee or ten,t) of the afores~d b~g. ' Suffolk Co~ty Dep~tment of He~th Approv~ ~.. 2~t. ~.. ~ .~,..~ .... FOBM NO. 2 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? 4687 Z Permission is hereby oranted to: Building Inspector. Building Inspector 'TOWN OF SOUTHOLD BUILDING DEPARTMENT Examined ................ /.~......~..~..., 19(.~... ^pproved ................. l. ............ ..~... 1 .9~.....~... Permit No ............................. TOWN CLERK'S OFFICE ~, N. Y. Disapproved a/c ..... """~' ~'""'~r ............. (Buirding Inspector) APPLICATION FOR BUILDING PERMIT ~ ~' Date ............................. /...~........~..~, .~,..., 19..L. ~..~ ~ 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 perm t 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~ code, housing code, and regulations. (Signature of applicant, or name, if a c0~poratlon) .......................................... ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ........ ..................................................... Name of owner of premises . ') ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /~A"/TI"rT,,,~/.~ ~ ~ 1. Location of land on which proposed work will be done. Map No.: ............ .~....~..~ ............ Lot No.:........................'-:~-- Street and Number .................................................. ~ ............................... ~ ....................................... /~-T/-I T~'C-/~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy L/~ c- drA/' r- J-OT 3. Nature of work (check which applicable): New;Buj!ding ..~ ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .............. .._~/Other Work (Descr be) .................................. 4. Estmated Cost c~.~. OO~ Fee ...'~..,~..(~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ J~.~..~....J-~.i~ ...... N~mber of dwelling units on each floor ............................ If garage, number of cars -~...'~. C-~/Z= 4D -- / ~'~) 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........: ................... 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 ................ .~'...Z ............ Rear .......... .~.....~.. ......... Depth ......c~.....~.. ........... Height ....... ~'..~.. ....... Number of Stories .................. ~.~.. -~... .................................. 9. Size of lot: Front ....................... .J..~..~f~eaXr ....~....~...~. ........................ Depth ............... ..~..:....~....~.... ~ 10. Date of Purchase ......................... /..~...~....~.. ................ Name of Former Owner ...~...~....-~..../.~..~.. ....... ~..~..~..~.~'.. 11. Zone or use d str ct n wh ch prem ses are s tuated ..................... 4.......'~....~.'...,~../...D..~/...A.....~_. .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation:~ ~7 o 13. Name of Owner of premises ~>/E~/A~'E) H/l~DHvl...~ddress (~/t~C,A~, ~ Phone No. Name of Architect ......~.........~....~.../../...~ ................. Address ...,..~.,~.....'~..../..7~....~.~ ......... Phone N~.~....o~......?.../,./...-~. Name of Contractor ............. ./?. ............. c.~ ..................... Address ................... ~.r. ....................... Phone No ........ .~ .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, arid indicate all set-back dimensions fram property lines. Give street and block number or description according t° deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ $ '~"~' .................................... -'~-...~..../~..~....~...~...-~ ....... ..~....~..!...~...~ ....... being duly sworn, ~eposes and says that he is the applicant (Name of individual signing application) above named. He is the ................. ~A/.?...J~....~., C ..'~'...O....~,. . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rr~ke and file this application; that all statements contained in this application are true to the best of bls knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this 21 ......................... .......................... .......................................................... '..\~,oun~y (Signature of applica/~) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date A~g~st 21, 1970 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilitiles for a structure at Map of Mattituck Estates~ Lot #35~ Corneri:ofBlosson ~nd and (Give deed location) located Card Drive~ (Southwest corner) Mattituck have been inspected by this department and found to be satisfactory. D. is t r i~ *-E~g ine'e r