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Home My WebLink About4020-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~;..348~ .... Date ............. May ..... 19,. ·., 19.63 THIS CERTIFIES that the building located at l, llll. Creek .Drtv~ .aut. Street Map No ............. Block No ........... Lot No.. S. auth~.d,. I~. ~.Qrk ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... septe, ml~r..3 ·., 19 68. pUrsuant to which Building Permit No.. 4020. ~. dated ....... Sep~,~l~r..3 ~.., 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 . .pr,t.vate. one- ~amtly, .dwel. tln9 ...................................... The certificate is issued to . G~.~e~'te. KumJ ~.~n ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .1~¥. ~.g,. ].9~go. l~ol~l:t .Villa... Bmld~ng Inspector FOltM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4020 Dote ....................... ~t; ........~ ............. , 19..68. Permission is hereby granted to: O~le~t ~¥,~ at premises located at ....... .~..~.......k[~,~.-~....C.~'~.~...D.~'~.U~..~.~II.~i ...................................................... .......................................... ~..u.t.~..ol~ ...... .~.,.~, ............... pursuan¢ to application dated ................... ~.~.:~.~. ....... ~ ......... , 19.~..., and approved by the Building Inspector. ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal (Give deed location) facilities for a structure located -- ~ have been inspected by this department and found to be satisfactory. w~,~ I. g 1gGg District ~ineer '~'"'~' ~' District Engineer ~N OF S~TH~D .BUILDING D[P~.~E~~ ~'~ T~N CLERK'S OFFICE ~ .......... v .............................. , ..... A~li~tlon .......... ~ ................ ~ed ........................................ , 19 ........ Permit No ............................. Di~pproved a/~ APPLICATION, · .FOR BUILDING PERMIT : Date September 3 19 68 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 showing location of lot and of buildings on premises, relationship to adjoining pr.emises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s port of this application. c. The work covered by this application may not be commenced before issuaflce of Building 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 in whole or Jn 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 Deportment 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply/3/ . ~/I z/,~'~wlth*all applica~e la,w), ordJr~n.ces, building code, housing code, and~ regulations. ~/~~'0 G:L'B~t'e lr.~J.~B ' r/i ......... O~*~.en~ li.~Z. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. rem se G Name of owner of p s ..~ .......... ~ .................... ~I....~1~... ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ....... ]Lt.l]...Cr. eek..D_-lT.e...WMl[ ........... 8o~tth~.;...Z ................................... ~' ~ ,_~ ~' Municipolit~/ 2. State existing use and occupancy of premises and int;er~d use and occupancy of proposed construction: a. Existing use and occupancy ......... .lr.l[K.~.~.~...~,.lll~i .............................................................................................. b. Intended use and occupancy O~e ~'ml.~.lZ 6vell:t~g 3. Nature of work (check which applicable): New Bbi!ding ..~ ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......~..~..t..~..O...O. ......................................... Fee ........ ~.g.~.~. ...................................................................... (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 same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~.~, ..................... Rear ........ 7.~.. ............... Depth ....~.~1.~..~...../..2.~.. Height .................... Number of Stories ..............'1.~ .................................................................................................... 9. Size of lot: Front ..... ~t;~t ................ Rear ........ .1l~1 ..................... Depth ....2~/...3.03 ......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1] Zone or use district in which premises are situated aaa 1~/ Does proposed' constrUchon violate any zoning Iow, ordinance or regulation? ................ ~ ...................................... 13. Name of Owner of premises ..~;l~¢..~.~.l[..[.l~ll~.:l, ll~..Address ............. .~.~1~.1~. ................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .....~..~....~..~.,~.~.~..~..~...~.~.~..~ .............. Address ......... .~..~..~....~..~.]'.9. ................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oll 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. STATE OF NEV~I~Ii~I~. COUNTY OF ................................ ¥~cent [~ ~ · .......................................................... ~.,,'.i;:.,, ............... ~,.:;.b¢mg ~dgly, sw,.Om~._-d,epqs~s~,qnd says that he is the applicant (Name of individual signing cippJication) above named. He is the ......................... A~e~..ef...~e.r ................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfor~ ~~ J~av~e~pe'r~'rmed the said work and to make and file this application; that all statements contained, iR this app!i.cadon are .t~H,e to the best of his knowledge and belief; and that the work will be performed in the manner ~et'forth ~'the~l~JpJic~ti6~ }tied therewith. Sworn to before me this / ~ ~'~ - / · .................. of ................. ................. , x2/' . , ;__ ora Pu t,'-~'~ . ,~_ ,¢ ,' .......... ~..~....~..../..~.T..T..7....~ ....... N ry b 'c,/. ~./~.,¢c.4~, ....f,(. ,....~.L~ou nty (Signa~/e of applicant~/ Term ~piree HOWARD ' CHARLES J. IRVVif~ -'3 HOWARD C, PE,ERSLN CDNSULTANI CH~iRLES ]. IRWIN '0 '8 HOWARD C. CHARLL,S J. HOWARD C. PETERSEN CHARLES J, IRWIN HOWARD C. PETERSEN CHARLES .I. tI~WIN