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Home My WebLink About5748-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS BUILDING PERMIT MUST BE KI ? ON THE PREMISES UNTIL FULL OF THE AUTHORIZED) N? Permission Z to at premises located at pursuon,t to application dated Building Inspector. Fee $. 2~[,~ I~ .......... 19..~,,., and approved by the SURVEY FOR CHARL£$ ~.~ AD£L£ A. WAH££R AT MATTITUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, N.~ SCALE: I"=~0' NOV.~6~I969 REFERENCE * GUARANTEED TO: THE TITLE GUARANTEE CO. CHARLES R.~ADELEA.WAHLER ~.A~O SURVEYOR N.Y.S. ~.IC. NO. RIVERHEAD~ N. Y. ~ /~ ~. ~.< BUILDING DEPARTMENT . / ~'~' ./ ' ~ ~ - ~ . T~WN CLERK'S OFFICE ~ / /~ ...... SOUTHOLD, N. Y. Disapproved a ......................................................................... / ................... .............................. '-~':C~7 ~" INSTRUCTIONS//z~.~ 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 ofproperty 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. cl. 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 in part for any purpose whatever until a Certificate of Occupancy .. shall have been granted by the Building Inspector. IAPPLICATION 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 ~,/~Re~ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~Th~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ~. // / .... ~..~...~..,. ........................ .,.,.,. ....... /...~;;..~.:,:>~: -~' ~ (Address of opJ~licont) State whether applicant is owner, lessee, agent, orchit~t, engineer, general contractor, electrician, p~mber or builder. Name of owner of prem~ses~ CO, ~ ~~ ~ ....................................................................................................................... ;~-~ ......................... ~..~.....: .... If applicant is a corporate, signature of duly authorized officer. ' (Name and title of corporate officer) Ma No ~ 1. Location of land on which proposed, v~ork~ill be cJone, p .: ........ 5~ ............ , ................. Lot No ........................ Street and Number .... ..~...~....../~....'~.:. ........... ~.~..~..,.//. ............ : ........................................ /. ~..~) r~unicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ....... ........................................................... b. Intended use and occupancy .~=.===.....~ ~ ........... / 3. Nature of work (check which applicable): New Building .................. Addition ........ Alteration ....: ........... 4. Estimated Cost ..~....~..?.~..O..O..:..O...O.. .................................. Fee ....... $ ,~OO~'.2. ........... ..................................................................... (to be paid on filing this application) 5. Jf dwelling, number of dwelling units ...~..Q..~/...c.~.)...J ....... Number of dwelling units on each floor ..(,.~.,/'~,.~.-~.~.....J .......... 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 ,J..L/. ................ Number of Stories ....~./~.~.-~....~..(.~. ....................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dirn. ensions of entire new construction: Front .................................... Rear ...... ~....~.....~..~....... Depth ...../..,,O.;?. .......... Height .................... Number of Stories .................. ? .................................................................................................. 9. SizeofJot: Front./.~2~2/ Rear 10. Date of Purchase ..~....7......~..?....L..?.....(..~..7.../. ................... Nome of Former Owner .~.../..~..~..~..6...~,~....Z~.;...../~..?,...~..Z...~..~.. ...... 1 ]. Zone or use district in which premises are situated ..~/;..%..~..~.;.~...~.,,.,...,.Z...~;..~.,,~...z...~.~..,..;~.~.~.....j~.~ .............. 12. Does proposed construction violate any zon ng aw, ordinance or regu at on? ./~....o.. ........................... 13. Name of Owner of premises ~.e..~-.~,?,,~...,w....£~../~..~.~..~.../~.Address k~.~,,'?T...~..~,.,~C/~,/T~,.~..,~../[.,~.Y-Phone No.~<~.~::~.~;/... Name of Architect ..../~.../.?...~....v?..'~.. ................................ Address .~...?..~....~..~'~. ...................... Phone No..~../~.~...~.G'~..... Name of Contractor .~.....~...~...~...~..'~.. ................................ Address .,,'~.....~.?....~...~.~,. ........................ Phone No..~....Q..~...~.~.'~.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whet~r interior or corner lot. STATE OF NEW YORK, COUNTY OF ...,~.~..~...~...~.o..~ .,¢. ...... ............. ~ ................................................................................ n~ duly sworn, d~oses and says that he is the applicam (Name of 'ndividual signing apphc~tion) above named. He is the ...~.~.~.~.~.~ ...................................................................................................... (Contractor, agent, corporate 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 belief; and that the wore will be performed in the manner set fodh in the aPpli~ti~ filed therewith. Swam to b~fore me this ..... -- .......... NOTARY PUBLIC, State of New York No. 52-8]25S50, Suffolk Term Expires March 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS /).k BUREAU OF ELECTRICIT~ ' ~-- 85 JOHN STREET, NEW YORK, NEW YORK t0038 N 19357~ THIS CE~IFIES THAT ~y t~ e~t~ ~u~nt ~ ~cH~ ~ ~ int~ ~ t~ ~t ~ o~ t~ ~ ~pl~ num~ in t~ of J. Pet~usk~s, Hill Street, Wlc~am & M~y's Rd., Mattltuck, L.Z. ~mu~ sxru~s ~A~ ~N~O~S ~ OWNS I I '~ 10r, C:~ X 1 2 1 4 · ~at co;~ Elec.Servlce, ~'::~ -, f),~trander Ave.} ;~[vorhead, L.I. 11901 P~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.