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Home My WebLink About4868-zFORM NO. 4 TOWN OF SOUTHOLI/ BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~, .4056 .... Date .. l::~¢eraDer ..... 3, ......... , 1970. THIS CERTIFIES that the building located at Ha.ywaters - &. Vans.ton- RoadStreet Map No...xxxx .... Block No.. 'xxxx" .Lot No. 3331 ' · Cutchogue~..New York. ·, Nassau Point conforms substantially to the Application for Building Per?nit heretofore filed in this office dated ... July. 2.2.1 ........ , 19.70. pursuant to which Building Permit No. 4868. dated ... July...22 ~ ........ , 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 ... pr irate, one · £am't'ly· dwelling ........ ' ............................. The certificate is issued to .... H~.J~ · S.t:einbricker - - · ............................ (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Novembgr- ~'01 · '1970~' Rober~ Building Inspector House %'s 1525 Haywaters Road 1525 Vanston Road FORlVl NO. ~ TOWN OF SOUTHOLD ,, BUILDING DEPARTMENT TOWN CLERK'S OFFICE. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS~:S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne ~868 Z Permission is hereby granted to: ; pursuan,t to application dated ......................... .~.~ .......... ~.... ...... , 19.....~ and approved by the Building Inspector. ......... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit i / ~-Dd~2 0 NO. TO WHOM IT MAY CONCERN: at have been The sewage disposal facilities for a structure located ~ Give deed location) / -, inspected by is department and f~und to be satisfactory. Chief of General E~ineerin~ Services DSstrict Engineer TOWN OF SOUTHOLD .~'~ ~ SOUTHOLD, N. Y. Examin~l ¢~_~Z. 197.0.. Approved ...... :.l. ............ , 19.!.I. .... Permit No.....~..-~....~....~.....~...... Disapproved a/c ............................................................. tar) BUILDING DEPARTMENT ~';/.,~/~ · ~'~,~ - ~'/~'"""~ /"-'~'"/' ~ TOWN CLERK'S OFFICE ~.,~4/ ~. 0 . Applicotion No ............................. APPLICATION FOR BUILDING PERM'I' ~ rote ................................. la.l.lr. ...... 22...., l¢...gO.~ I,n INSTRUCTIONS ~ .( a. This application must be completely filled in by typewriter Or in ink und submi;ted in duplicate to the Bud ~ ~ Inspector. ~ ~ b. Plot plan showing location of lot and Q~ b~lding~ ~p~e~o i.~ relgti, ,¢~hip to acljqining;pm~sa$,er;l~Ublie $~ets or ~ ~. '~'l~c~r~ ~ve~Pe~y~t~s appJ~cafi~ may n~e commenced before ~ssuance of Bud~lt~, ~' ~ ',:~.-~' ' ',~' ::~:',~. ~ d. Up~ ~al of this application, the Building Ins~ctor will i~ue a Building Pe~it to the applicant Such ~ ~all ~ k~t ~ the premiss ~ailable for inspection throughout the p~r~s of the work. ~ ~~ e. No building s~ll be occupied or u~d in whole or in pa~ for any pu~ose whatever until a Ce~lficate of ~c~ncy ~ shall h~ been gmnt~ by the Building Insp~r. ~ APPLI~TION IS ~REBY ~DE to the Buildi~ De~rtment for the issuance of a Building Permit pumuant to the Building Zone O~inance of the To~ of.Southold, Suffolk County, New York, end other applicable La~, O~ ~es or Regulations, for the construction of buildings, additions or alterations, or for rem~al or demo It on, os heroin d~cri~d ~e applicant ~r~s to comply with all applicable la~, ordinance, building c~e, housing c~e, and regulations. ' ...................... '. ........................ (Signature cf applicant, or name, If a co~mtlon) Mattituek (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ .~ontrac.tor. ................................................................................................................ Nome of owner of premises .....,~.,:~..,...~.~..e.....:~..~.Z'.,.~.~,e.~ ...................................................................................................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and title'of corporate officer) , ' 1 I , ~ ~ ~ I : : ~ I ~ 1. Location of land on Which proposed work will be done, Map No.: N&s~e~..~;t~ .................. Lot No.: ...~. ........... Street and Number .... .~_'_~a. tea:s..~...1[ams.ton..]Rc! .............. .~a.%~$~e:.':-i::..~.'::;~::.:.~::::.:::.':;.::':..: ...... .............. .,~,'.?..~'-~_~2 _~ -~ · /T/ - /5 .~ 5. --J. · Municipality ....... , .! 2. Stoie exist~ng,~s~ and occupancy of'premises and Intended use and occupancy of proposed cor~truction: .'o :,~g,h~.~[~F.~jsti_ng uaemnd occupancy VA(~a33t, - b. Intended use ond occupanc,'. .......... e=e...~a~:~,...a~-e,~l:La& ........................................... ;: .......... ~ ............. 3. Nature of woik (check which applicable): New Building ..... ~ ...... Addition .................. Alteration/./ ........... Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. ~f'"//! ............... 4. Estimated Cost ..........2~,.00~.....~. . . Fee (to be paid on filing this application) 5. If dwelling, number of dwel[ing units ...... O~ ............... Number of dwelling units on each flor ............................ 3 ~oture of wo,~ (ch~ which aopi~e): New Building ................. Addition ......... r ........ A~er~tion .............. ~ garage, number OT CO~ .~W~ . ~'~air ............... R~ova!., ............... Dem~lit~o~ ................ Other Wor~ [D~scribe) 6. It Duslness, commercial or mlxe~ ~cu~ncy, speci~ nature and extent of ~ch ~pe ~'~e"[~[~[~.~ Hei, grht ................... ,~umu bet of Star ~ .............................................. ~x I~ ~weHing, n~mber o~ dwelling umts ............ ~6m~er of ~well ng un fs on each T oar :t ....:.:... D[mensio6s of same structure with alterations or additions: Front ....................................Rear ............................ pin : ............................... ~e gnt ............................ mumDer at ~torms ................................ ~. ~ir~l~ ~ ~ ' ~c cv, speci a and tent of pe of e ....... ] ~u~,~s on~ of ~ ,.,st r,~6¥r~tures, ~. any: Fron~. ....................... Rear ............................... Depth ................. q ,. ......... ~umber o~ ~or'ies ........................................................................................... 9. ~ ~Ot. Ftt~t ...... ~..~ .......... ~ear ....~.0~..~ ................... D~p}~ ....... 2~..~ ............ 10. ~cn~; c~f ~arre structure with alterctions or additions: F;~t ....... ~ .......................... Rear ............................ a~e aT rurcnase ........................................................ Name aT former ~er ....................................................... '. ~ .............. =' ht .... ~ tares . law oralnonce or /egu OtlO~. ~ ........................... '..'.' ~e f ....... : ..... N~mb.~ a St i.s .................................................................................................. 13. o ~ner o~ prem,ses ~,~,..~~=.~dress .............................. Phone No .................... ~ ~:.~' o~: lot: Front ........................ r?ear .................................. Depth ............................... Name 9f Architect A~ress ~, ~ P~ne o ....... ¢.A~ress ~~ P~ne No p~e~ lines. Give street and bilk number or description.qccording to d~, and show str~ na~ and indicate whethe~ ~t~i~ ~tlot.. .................................................. Aaaress ............................................ mane ~o .................... ~.~.r .... h .............................................. Addru~s ........................................... Phone No ................. STATE OF NEW YORK, COUNTY OF ...~.:g,~.~,,~ ........... Arnold .......................................................... :~ ..................................... ~mg duly sworn, d$~s and say~ fl~t he is the applicant (Name of individual signing application) above named. He is the .................... Celx~-~t .................................................... '~[ ....................................................... (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 am true to the best of h s knowledge and belief; and that the work will be performed in the manner set forth m the application f ed therewith. Sworn to before me this ' ................... · ~.~.h ~ .. /") ~'~ .e~'day. of ......................... .A,.,~..~.. ...... , 19..?..0.... .... ~ ~ ~_~ Notary r~ountye/~.~__~ (Signature of app~llcant) ELIZABETH ~N~I NEVILrLE NOTARY PUBLIC, State of Now yot'k No. 52.8125850, Suffolk CouJ~J, Term F. xpirl~ March 30,