HomeMy WebLinkAbout4857-z �. FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. L41$3 . . . . . . Date . . . . . . . . . . Feb. . . . .9. . . . . . . .. 19. .71
THIS CERTIFIES that the building located at .Sound .View..Avo . . . . . . . . . . Street
Map No. . . JU. . . . . . . Block No. XXX . . . . . .Lot No. . .XXXX . . . . kattLtuek • •N.Y. .
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . . . . . . . jay. . .14. . . . .. 19. 7.0 pursuant to which Building Permit No. .4057z.
dated . . . . . . . July. . . .14. . . . , 19-70, 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . xartU. .L.*wb. . . . . . .QVVor . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Fob . .9,. .1971• . •by. J4 . Villa. . . . . .
House 0 65 q�-w G„
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
' Building Inspector
FORM NO. R
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° 4857 Z Date .........................z14a4.......tk.......... 19..70.
Permission is hereby granted to:
..........UWri .-bea0a.....A,r,.4w"j*.jdv
....................stww-•A,rook. ...............................
................................................................................
to .......Huilld.-new..our..eaal ly•dwiZtog............................................................................
................................................................................................................................................................
at premises located at ....XA�....SOttHldr••yLgW..pYY.. ..) Afp ..............................................
........................................................... ................................................................
................................................................................................................................................................
pursuant to application dated ........................r za r..........311►............. 19...'tTQ, and approved by the
Building Inspector.
Fee $.W.W
X . f:. .:.-- ���.rrr(((��� ................
Building Inspector
,/r
.. .
FORK'no. l
0 ;
TOWN OF SOUTNOLD f 7 70 P 3
,BUILDING DEPARTMENT /
TOWN CLERKS OFFICE
SOUTHOLD, N. Y. ; �d/7O p, r� _ 1p¢e� 3s- ` (( ' /w o e 3
Examined .......... . .......... .......5.. ., 19...t.V 40' r Application No. .4.T�.�..............
Approved ...............................0......, 19.. ... Permit No. . � '
/ /-7o.............j /1/� ld
Disapproved o/c ............. .. . -- ....... ................
i`
..................................................... t .
.................. ..... ............................... . .......... ..... .
21—
lie
na APPLICATION I!QR BUILDING PERMIT
Date ........................;VAq.....A................. 19...7..0
....
- INSTRUCTIONS �1
a. This application must be completely filled in by typewriter or in ink and submitted In duplicate to the Buildingb
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinsnp promises or public struts or
areas,and giving a detailed description of layout of property must be drawn on the diagram whhich is port 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 o Building Permit to the applicant. Such permit T,
Shall be kept on the promises 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. 3,
APPLICATION IS HEREBY MADE to the Builds Department for the Issuance of a Building Permit It
ng pa g pursuant to the 1
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, housing code, and regulations.
.....]DA.7rfA.............................................................
(Signature of applicant, or name, if a corporation)
.........12....53 YJArk.....a....atony-Brook.......................
(Ad&oss of applicant)
State whether applicant is owner, losses, agent, architect, engineer, general contractor, electrician, plumber or builder.
..........................................Qt.WtIzAA19..r...............................................................................................................................
Name of owner of premises ....2faztJ.n..I"b.....................................................................................................................
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.: .......XX........................... Lot No.: ........=.........
Street and Number ......... I*(&..SaundvSex..Ase...............Uttituck...................................................
/F/ /a JC Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....Va baatt..................................................................................................................
b. Intended use and occuponc..'....... no.....fats#ly..dq*1-1-I 3R..........................................................................
Flit
3. Nature of work (check which applicable): New Building ,XXXIL...... Addition .............I.... Alteration ..................
Repair ................. Removal Demolition.................. Other Work (Describe) ........................................
4. Estimated Cost .......1$1(=......................................Fee .,......1(Q.AO......................................................................
(to be paid on Wing this application)
5. If dwelling, number of dwelling units .JR ..................Number of dwelling units on each floor ............................
Ifgarage, number of cars ..........2.....................................................................
..................................................:........
b. 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 some structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................Number of Stories ................................
8. Dimensions of entire new construction: Front ,.........60..................... Rear......60................. Depth .....W..2i6....
Height .................... Number of Stories ......QXW
.........................................................................................................
9. Size of lot: Front ........1.1a............. Rear .................................... Depth'....1+87.....................
10. Date of Purchase ........................................................Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ..W..Cusst...............................................................................
12. Does proposed gbrrstruct on violcte any zoning low, ordinance or regulation? .................gyp......................................
13. Name of Owner of premises .Xaptia....Lgab.........Address ...Ykasaplaqua................ Phone No. ....................
Name of Architect .... h.&1F.t..I?'>A.......................Address ...ZAYPOrt....................... Phone No. ....................
Nome of Contractor ..H&peld•••Belaes.....................Address ......St my..B2ook........... Phone No. ....................
PLOT DIAGRAM
Locate clearly and distinctly all building yvhether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block num r description according to deed, and show street names and indicate
whether interior or comer lot.
-.
COUNTY OF ................ JS /
STA E OF NEW Syalk
••••••••••••••••••••••••••..'Ea-Pold••20"s......................................bei duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ..................COIItTYC:tors...............................................
..........
.....................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that all statements contained in this application are true t "the t of his knowledge and belief; and
that the work will be performed in the manner set forth in the appli on filA- �trh.Swom to before me this..................1�k. Coy of .L�. G� . , 19..jG .............. ............. ......Notary Public, Coun e of opplicant)
IZABETN ANN MILLIE
NOTARY PUBLIC, State of Now Yak.
No. 52-8125850, Suffolk Cou
Term Expires March 3D, 19
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date 76
Bldg . Permit No .
TO WHOM IT MAY CONCERN :
The sewage disposal facilities for a structure located
aty �/s / ,-� maF �D _
(Give deed location)
have been inspected by this department and found to be satisfactory .
O�Vi�7/t 0, U
Chief of General Engineering Services
FEB 9 1971 District Engineer
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CONSULTANT
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ARCHnCT
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COBSHETAM
CHARLES J. IRWIN
ARCHITECT
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CONSULTANT
3 CHARLES J. 1RWIN
ARCHITECT
290 BAYPORT AVE., BAYPORT, N. Y. r
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SURVEY OF PROPERTY
SITUATFD 21T
MATITRICK
TOWN OF SOUTHOLD
N 6534 39� SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000--99--03-02
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