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Home My WebLink About4083-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z56 O ...... Date ........... l~ovs~ab~w · · g, ·.., 19 69. THIS CERTIFIES that the building located at S~2i 'DI" 'S6~tt~ .......... Street Map No. Goose. ~eok Block No...xx ...... Lot No..$2L~. &1,2~ .... Sot~theld, .N .][., .. conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated ........... Oct .... 11'" 19.. 68 pursuant to which Building Permit No...i~$3Z. dated ............. 0b'~' ' YT" 19.68' 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 ... 9riva~ce. one · family' d~el.ling .................................... The certificate is issued to .... A.t.fre* -Hebenkla~t ....... 0w~ez, ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... 1~ ,R, ............................ Building Inspector I~ORM NO. ~ 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? 4083 Permission is hereby granted to: / ~ F~ ~) ~'~ ~ E N ~ L A U at premises located ot ........................................................................................................ pursuo~ to opplicotion d~ ................................. /..~.......~..~,.., 19..~ and appr~ by the Building Inspector. Fee $ ........................ Building Inspector TOWN OF SOUTHOLD BUll,DING DI:pAI[TMF,.NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............................ ~ ........... , ~y ...... ermt No. - 7 APPLICATION FOR BUILDING PERMIT ,,ate ................................ ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. ' · ,. b. Plot plan show ng ocotion of lot and of building~ on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description Of layout of property must be drown on the diagram which is port of this application. c. The work covered by this application may' not be commenced before issuance of Buildiqg Permit. d. 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 Jn whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLIC_~TION IS H.EREBY/v~DE 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 Regulations, for the construction of buildings, additions or a terations or for removal or demol t on, as here n descr bed. The applicant agrees to comply with all applicable laws, ordinanc.~,~ Id' g code, h sin code, and r utations. " gt31g ture of applicant, or name, if a corporat'onl (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner L~'~'~-Z~ ~--'1~--~N ~<~ L A U Name of of premises ........ ~ ...................................... · .~-... .......................................................................................... If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) · k lib d Ma No : ///6~'-~ LtN' /~'7-~ 1 Location of land On which proposed war wi · one. p .: ........................................ o o.: ........................ X/ Street and NUmber ................. ~ ...... ,~..,. ......................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy D YL/L~/., L ~ N ~-- b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Es. mated Cost ........ ........ Fee ........... ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .~....'~..C ...... Number of dwelling units on each floor ....~...~.....~:,-: ......... If garage, number of cars ~/I/~- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of ex s~ ng structures, if any' Front ~:~ ~. Rear ,~..~..... . Depth ~ ~... / ........................... -- ............. F .................... r ...... Height ....... /...~.. .......... Number of Stories ......................... ..~.....~,..~7.~. ........................................................................ Dimensions of same structure with alterations or additions: Front .............. ...~.....~. ............ Rear ........~......~. ............ Depth ......... "'~:'"'7' ............. Height ............. /...~.. ........ Number of Stories .............~...../~.....~..~. ...... I 8, Dimensions of entire new construction: Front ............... ../..?.. ....... Rear ~..~ Depth Height ........ /..~.. Number of Stories .................... ..~....'~.....'.~......iii.iii ......... iiiiii.iiiiiiiiiiiiiiiiiiii; ............ 9. Size of lot: Front ........./....~.....,~.. ..... Rear .......... .~.....~_....~.. ............ Depth ........ /....~, ....~. .......... 10. Date of Purchase ....................... ./..~......~......~.. ....... Nome of Former Owner .~....~..~...~..~"'/~ Z ~' '~ ~' ~ ..... > ................................. 1 I. one or use district in which premises are situated ......................... ~ ................ ~d~..~'..!....~....-~..~....7...(...~..,/. ............... 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ~ ?. .............................. 13. Nome of Owner of premises. -~........~....~..~.?....~'...~....~...~...~.A~dress ....... ..~...~..../~....../~....~....l~...l.~,~. No.7.~.'..'.~..7.~.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... '~ ntractor "~A~ ~' Name of ~.o : ................ ~. ................................ 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 bk ck number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, J, c ~' 1~41Tt-/.~ ~1~}~ t V' I~-- -.~ OO ~ cou, ,,,, " .................... I..'~rr......_,lC.,~:'~......%~ .t..~'...~. ,..,¢':C~....~...v......'~Z... ....... ~ being duly sworn, deposes and sa,,s that he is the a~licant (Name(6[ individGol signing appli;g;ig~i ................. above named. H~ls 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 rnoke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the appli~c ~f~ed therewith.// Swom to bejore me this ~,~,~tl~ ~r' ~"J '~ ~.,'~,,~..,~'/~., ~ /~. ........ ......... day of ...... .................. , Notary Pub~mc,~......~.,~nty"'"~ ........ i~"g~;t~re of applicant) ....... [MARION A. RE~ENT ~ !1 NOTARY~UBLIC, State of NeW ve,~ ~ No. 52.3233120 Suffol:: C: Y h :Tim Expires March 3~,