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Home My WebLink About7933-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Off, ice Southold, N. Y. Certificate Of Occupancy No. ~68~O ..... Date ............... Ja~ ..... 20., 19. -76 THIS CERTIFIES that the building located at R,-0,W., .S/I~. ~est P~Zt- P~i Street Map No..:~ ........ Block No...Xx ..... Lot No. l~:~.. · Matt~.tu~ .... ~/,~.~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Feb' 2'1 19 .?~. pursuant to which Building Permit No.. dated ...... lqa~' . .46... , 197~.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is 'Pr~'vate..aeee-sser~ .btttldi~.. (~pl0rove~. by. Bd Al~peals) ......... The certificate is issued to . .14r~ .M$;[3..$am ];$llt~ . · ~et~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. N.,.R, ........................... UNDERWRITERS CERTIFICATE No. N,R~, ........................................ HOUSE NUMBER . .~'10~ ..... Street .... West. ~il~L .lload .... 14atti.tuek ...... Building Inspectort FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 7933 Z Permission is hereby granted to: ....... ~z~.~..<.~z...~... ~.z~o.... ..~..~...o....:...~.........:....~//... ..~..~...:... ........... ~~~. .~...~ :.~. ,o ...d~.~zc.c..~~..<.c.~.~.~.~.~....~2~~ ..... ~. .. ~.~.. et premises located et ........................................................ ~.~.r~.... ~.~.o.....~.~.~.....~/~....~~.~.~..~ ...................................... ......................................................... ~~z~.c~....r.~..~.~~_ ~ ~, ............................... Buildin~ Inspector. , I, f 7 TOWN OF $OUTHOLD BUILDING DEF*RTMENT ~_~~~ TO~ CLERK'S OFFICE ~UTHOLD, H. Y. ................. ............. ,;';;'"' Z2 rrz ........ · ~¢ ~.~/ A~PLICATIOH FOR BUILDING PE~IT INSTRUCTIONS a. Th~s application must be completely fzlled m by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of braidings on premises,'relationship to adjoining premises or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the d~agrom which is part of thru applicatio, c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occuponc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors an premises and in buildings for necessary inspections. a~dplicant, or name, if a corporation) R.O.W S/S West Mill Road Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~lde, Nome of owner of premises .... a...~..$,l-.-~$.~,~t...~.~-..1.~.$.~.. ........................................................................................ If applicant ~s a corporate, signature of duly authorized officer. (Name and title of c~rporate officer) Builder's License No ............ ~ ....... ..../. ............... / Plumber's License No ............... V ...................... Electrician's License No ...... ....~._.~ ................ Other Trade's License No ............................................... Location of land on whmh proposed work will be done. Map No...~[T, ........................... Lot No..;Jl~ ............. Street and Number ~.e.~}.e.l~.~...f}~'.~..~/~...~JtD.~..~L..~Qa,~ ....... ~.~;[.tcl~¢.J~.....~.*L~.t ................................ ~5-~00 ~-) ' ~ ' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy .... .~.~.~..~.~..~..~.J[ ............................................................................................... b Intended use and occupancy ......... .~.~_l~...e....~...J:,~...~...a~.......a..o..a...e.~.~.°...~.~....~.'!-...~.~. .................................................... 3Nature of work (check ~licable). New Buildm~ · .~1[;~ ........................ Alteration Repmr ................. Removal .-.~ ........ Demohhor ........... Other Work ............................................... (Description) 4 Estimated Cost .........~ ~,,/, ,~c".,~ ..~..........:....../..~(~...... ~c-,~ ...... Fee 1Oo00 ................................................................ (to be paid on filing th~s apphcahon) 5. If dwelling, number of dwelling umts ......... O33~ ......... Number of dwelling umts on each floor .......................... If garage, number of cars ......................................................................................................................... 6 If bumness, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 Dimenmons of exmtmg structures, if any' Front ................. Rear ................................Depth .................. Height ........................ Number of Storms ....................................................................................................... D~mensions of same structure with alterahons or addmons Front .................................... Rear .................. Depth ................................Height ..................... Number of Stones .............................. I D~mensions of enhre new construchon' Front ........... ~. ..................Rear .........~.1. ............. Depth ...... ~.~. ..... Height .... ~.! .......... Number of Stones ...... · .............................................................................................. Size of lot: Front ...................................................... Rear .......................................Depth .............................. Date of Purchase ............................................. Name of Former Owner ...................................................... Zone or use district in which premmes are situated .l~A. tl...~,l~t~ ....................................................................... Does proposed construchon wolate any zoning law, ordinance or regulation ~r~ ................................................ Wdl lot be regraded .............. 1~ ......... Will excess fill be removed from premises: ( } Yes (:X~ No Name of Owner of premmes ..~Yf,~...~i~-,~L~,c,~..~],~;~b~... Address ..... ~t~,~1~¢ .... Phone No...2~)8..~.~... Name of Architect ........ h[~n.l ....................... Address ........... .-. ...................Phone No ....... ~ ............ Nome of Contractor ........ ~.~ .~..~....,-~. e~ ........... Address ...... .J~.~.~..~.. ....... Phone No ..... .2..~....~)....~. PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether ex~sting or proposed, and mdmate all set-back d~mensions fror property hnes Gtve street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot ,~,, 8 9 10. 11. 12 13 14. STATE OF NEW YORK, [S COUNTY OF ..~1~'O-~ ............ ~ S ..... .~...~../-~..!.~....~.....~.....~...6...~....~...,-~...........J~...~..~ .............. be,ng duly sworn, deposes and says that he ,s the apphcar (Name of mdivlduaJ s~gnmg contracf) above named He ~s the ............................................................................................................................................................... O of sa,d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fd this applicahon; that all statements contmned ~n this apphcation are true to the best of his knowledge and belief, an that the work wdl be performed in the manner set forth m the apphcahgn-Jiled therewith ..,,-- Sworn to before me this ....................... aay ............................ , I iNotary LDI C, ............................................... ;.,T ~ounTy ,~..~¢ ......................................... / ......................................... -- (S~gnature/of applicant) ROBERT A. PARKIN Notary Public, State of New York No. 52.8280300, SuH~lk CougtY Term Explre~ IVla~ch ~O, 19~,