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Home My WebLink About4509-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..3710 .. Date . December 31 , 19 69 THIS CERTIFIES that the building located at South Lane Street Map No. XXX Block No. Lot No. xX East I¢~arion, Ft,]/, conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct 16 , 19 69 pursuant to which Building Permit No. 1+509Z dated ..... 0c~; . 16. , 19 69 , 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 . Prfvata .~ne. family dwelling .................. The certificate is issued to ~Okn 8kOp. o. lt ..... 0Wl~e.T ................ (owner, lessee or tenant' of the aforesatd building. Suffolk County Department of Health Approval N,I~. ..... Building Inspector ~ouse ~ 6~0 FORM NO. ~ TOWN O~ $O~TBOLD 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? 509 Z Permission Is hereby granted to: &~..~e~l~..~.a....~..~telm. ~ ...... ................. ~t~t~tm~ ........................................ at premises located at ................... ~01~-.~!lr3~lt *--.(~t~..O]L~:)--~-~l[t ......................... ......................................... -~-,..l~e~ ........... ti1,~, ....... : .................................. : ............................ pursuon¢ to application doted ........................... ~lt~;. ......... ~6 ........... , 19.l~9.., and approved by the Building Inspector. .Fee ~QO- .............. i TOWN OF SOUTHOLD BUILDING DEPARTMEKI' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No. Disapproved a/c .............................................................................................. (Building Inspector) ^pp,ication No....~....~..~.~.. ~ APPLICATION FOR BUILDING PERMrT oate ...... ............. ..0..e..t.. .............. !6 ........ :....., 19..69 ...... 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 premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is Ix~ of this application. 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 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. APPLICATION 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hOUsing cede, ond regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... .c...o.~,~..a..~ .t;.9.r. .................................................................................................................... Name of owner of premises ...... .J....o...hD.....S.~g~, ............................ i ...................................................................................... 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.: ....... XZ ............ Street and &~ South Lane E. l~ar~..o..n., .N.~ Numbe~. .............................................................................................................................................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exis~ng use ond occupancy ........... ..d..w...e..1...1...ig.g .................................................................................................... b. Intended use and occupancy ............ sam~..w~Ltl~..&n..&~t, ashe~..~a~a~e ................................................. 3. Nature of work (check which applicable): New Building. .................. Addition ~ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Iqoo 4. Estimated Cost .................................................... : ....... Fee .......................................................................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................. of If garage, number c~rs ....................................................................... 6. If business, commercial o~ 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 ............. i~ ............. Number of Stories ................................ 8. Dimensions of entire new construction: Front ! ~ . Re [ ~ .............................. ~ ....................... Depth ........................ Height .................... Number of Stories .............~ ....................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ................................................ ;. ...... l~ne of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ................................................ ~ ~,,~ ............................................. ]2. Does proposed c0nstruction.violgte~any 7.~9!ng lay/, ordinance or r~,g~lation? .............................................. ]3. Name of Owner of pram sas ~)~ ...~/.~...C...'~.....Address ~ ' ~{'{ ~ Phon ' '"' Name of Architect ...................................................... Address ......... .,.,,~.,~,,~..., ................. Phone No. Name of Contractor ...,.~...:.~.~.~..'~.. ................. Address ... ~.~....:~ ................ Phone No. PLOT DIAGRAM Locate clearly and distinctly oil bUildings, whether existing or proposed, and nd cate a I set-b~ck dimensions from property I~nes. Give street and block number or description according to de~d, and show street nomes and indicate whether interior or corner lot. TATE OF NEW YORK, o-('~ ~S.S COUJ TY/oO.F . ........ · ........................ · .'"':".' .......... .' ................................... g Y , ep y ' app icant .... ('J~'r~I of Individual slgnl,ng application) above named. He is the ....................i ......................... i ........................... ~ ........ ~ ........................... (Contractor, agent,, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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 application filed therewith. Sworn to before me this · / ~ day of ~ ....... ' ry ,' .......................... ; ........ .~.~. ............... County ................... (~i~natur,o~'~ .... MAR ON A. RESENT v NOTARY PUBLIC, State of New Yor~' No. 52.3233120 Saf/olk Counb ,Terlll ~.pJre$ March 30, 19,.~