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Home My WebLink About5272-zFORM NO. 4 TOWN OF SOUTHOLD BUILBING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z~+2. ..... Date ............... April...5..., 19.~1+. THIS CERTIFIES that the building located at Ro0olg....E/. Coxneek. Roa~. Street Map No..~ ........ Block No..~ ....... Lot No. ~... ~tt[tuck...N.Y., ........ confo~ subst~ti~ly to the Application for B~l~g Pemit heretofore ~ed ~ ~ office dated ........ ~y ..... 3 ...., 19.71. p~su~t to wMch B~l~g Permit No. ~272~.. dated .......... .~. .... 3..., 197}.., was ~sued, ~d confoms to ~ of the req~ ments of ~e applicable pro~sio~ of ~e law. ~e occup~cy for which ~s certffica~ is issued is .Prl~te..~ne. l~il~ .~.ll~g ...... ~.. ~.~ ~. ~~..(~! ~6z ) The certificate is ~su~ to Soberer. & Di~e. A~s~ ....... ~era ............. (owner, lessee or ten,t) of ~e Mores~d buil~g. S~olk Co~ty Dep~tment of He~th Approv~ ~e. 28s. 1.~71...by. ~,Vll~ ...... UNDER~ITERS CERTIFICATE No..N~62S .................................... HOUSE NUMBER 8~ .......... SMeet ... C. ox. Back. ~d ....................... Buildin~ I.n~ector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 5272 Z ................................... , ....... Permission is hereby grant...ed...t°:.~)-~ ~ ' ~ ...~.~....~~----gT..~ .~., ?...~ ~~ ......... ~..~ ........ i~..~. ....... ;;'~Zi'ZZT'Y"EJ~'"'"~ ....... >~,.;'"~'~':'"~';:'i~ ........... w .............................. Y'~='~.t'~.:'~ *-~""u "~'"'/'"" ~"~· ......................................................... .-~-'-.'~'~-.~-~--.._,_,_>_ _. , ,_ , .... .................................................. ,~**..~h..~**.c~.***%./.~..~.~..~ ............................................ pursuant ,o application dated ..................... ~..6~.~.'.~...~ ....... . 19...?....~., and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT oF HEALTH Bldg. P~rmit No. 5P7P, Z TO WHOM IT MAY CONCERN: The sewage disposal faciliti~s for a structure at N/S of Middle Road 177.84" E/O Cox Necki Road, Mattituck~ (Give deed location) located Property of Robert and Diane Adamson have been inspected by this department and found to be satisfactory. Chief of General Engineering, Servic~ FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy 71 THIS CERTIFIES that the building located at ............................ Street Map No. ~ ........ Block No.. ~ ...... Lot No. ~e I~tt~t~llk I.~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ ... ~ ..... , 19 7¶ pursuant to which Building Pemit No. ~ dated ........... . .~.~....~. .... , 19 7!., 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 . .~..t,.~...~...~..I.. f..~.~..~...~..~....3.~.. ! ....... &...&QO.e.~.~.~..~..b.l~L~3..~:l~gl~..(h...'156Z) The certificate is issued to. ae.~...~...~!...~. ...... . .o~..e..~ .............. .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Building lmPeetor BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU OLD, N. y. EXomi fled ........ ~./.[...~... ....... ~'~ .......... , 19....~...~ f -- A roved ...........% . Pe,,,t No. ................................................................ .......... ...... ............................................................ ~ ............... ~.. . ................ APPLICATION FOR BUILDING PERMIT (~ Dote .............. .bie~.... 8. ................................. , 19_7.1. ..... INSTRUCTIONS o~ 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, andglving a de,ailed description of layout of property/must be drawn on the diagram wh ch s part of this application. c. The wo~ covered by this appli.cation 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 appl cant. Such permit-- shall be kept on the premises available for i,~oection 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 Bu Idina Perm t aur~uant to the ~ ,,udders.. Zone. O~mance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Kegu~a~ons, ~or the construction of buildings, additions or alterations, or for removal or demo Jt on, as herein descr bed The aPPlicant agrees to comply with all applicable laws, ordi~~code, and regulqJtions. i ........................ (Signature cf applicant, or name, if a corporation) · .BetoN. to...B~y.. ~B .1.v.d.,....Lau~.e ~L ,... ~ .. M ........................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. O~e~ ....................................................................................................................................................... Robert and ])ia~e Adamson Name of owner of premises ................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~'~ 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ....................... Street and Number .... .~.~/.~..a~`~.~..~c~L..~.~.~...~.?...H`/.~...~.~..~0.~.~..~...~.~.~.~.~...~.:.~.~.... 2. Stote existing use and occupancy of premises and intendec[ ~se and occuponcy of proposed construction: a. Existing use and occupancy ............. ~'~ .................................................................................................. b. Intended use ond occuponcy' ........... ~£~,~ ................................................................................................ ~ ' ' ROUSe v -- '~ '"' - '.~ ~ . .~- ~raile. 3. Nature of work (check which applicable): New Building .....~. ............ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Ofher Work (Describe) ........................................ 4~ Estimated Cost ...$1Q,D. QO ........................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ 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, 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 ..~.0.. Rear ...~. .................... Depth .....~...~. .............. Height .....,~. ........ Number of Stories .......... 1 ................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ....... ~/~./..65 ............................... Name of Former Owner ....... ~.....]~u&:].oc,k ........................ 11. Zone or use district in which premises are situated ....... R~a,t~e~t,,1~.,~,/~£c,u.:].t,3.1~a.1 .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ....~ .................................................. 13. Name of Owner of premises .~..~,d~,~on. .............. Address .~x..~O.6~,~.~.e.le~Y.. Phone No.....$.~..~.-.~.~..2.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shOw street names and indicate whether interior or corner lot. SEE ATTACHED SURVEY STATE OF NE'%~YOI~ //.- 'lee COUNTY __ ......................... //y.....;:...~..~.~.~...~.....~.......~..Z~...*.~w~'.J...~4J>eing duly sworn, d~oses and says t~t he is the applicant (No~e~f indivFdual signing application) ,. . above name. He is the ............................ ~.~...~..~ ......................................... .'.~ ....................................................... (~ntractor, ~t, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements contained in this application are tree to the ~st of his knowl~ge and belief; and tha~ the work will be performed in the manner set fo~h in the applicati~ ~r~it~. Swam to before me this ( .............. Notaw Public,~~.~.... C~n~T~tW ' (~g~a~e of applicant) ................. ~ ELI~B~H ANN NWIL~ ' NOTARY PUBLIC, ~te of New YOrk No. 52-8~25850, ~lk Cou~ Term Expires March ~. ,¢ p 5'.27;,',',l 7-,. f