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Home My WebLink About4590-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. g3.8.7.9 ...... Date .......... July ..... ~79. ....., lg.?o. THIS CERTIFIES that the building located at .Henx'y. Lane ............... Street Map No. Poe,- Itom~llBlock No ........... Lot No. 8 ....... Peeon~.o...N.Y., ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Dee .... 8 ...... , 1969. pursuant to which Building Permit No. dated .......... Dso....16..., 1969., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private. one. family' dwet'l'~ng ...................................... The certificate is issued to Xnge. Clausen-. builder..to .Mrs. Eileen .0~ll®t.t .. owne~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 0ct~' 98~ '1969' · by 'R~' -Villa. .... ]iOTEI ti~ndow ~ariance approved by Hou~g Bo.a~r~o.f.-~eals ..... (..s~....~.~...b.....~...'~ ........... Building Inspector ~ouse ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~590 Z Permission is hereby granted to: .................. .Z.~.e....~.e...a. ................................. .......... ~.~....~. ~,~..~a~ .................... to ............. ~e~A.. e~ · ~t4~$es..~. ~r, te~l~-. ~m;~.$~lt ................................................. at premises located at ................. ~'~.~..-.]~..]~ll.....~,4i~-,.][. ....................................... ....................................................... /~m~ ~e..~ .......... ~eeea~e ....... I~,~., ................................ pursucn,t to ~pplication dated ............................... ..~..~,t~. ....... .~.~ ......... , 19.,..~.~, and approved by the Building Inspector. ~e~ ~....~¢~,....:. .... Approved ........................................ , 19 ........ Permit No .......... Disapproved a/c ............................................................................................. APPLICATION FOR BUILDING PERMI'I' .................................... , ~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 part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ~1~ 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. "1 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 o.f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations. (81gnature of applicant, or name, if a corporation) (~Kddress of applicant) ~' State whether applicant is owner,~~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~.,~......./.,~.,.......~..~...~....~.....~....~..~ ........................................................................... If opplicant is a corporote, 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.: ........................ __/~ 7 _,,.b:~' ....... ~' ....................................................................................................Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........... ./.~..~..'~....~.. ....................................................................................... b. Intended use and occupancy ..... ~.~.../.~.~...~.......~....~----__ ..................................................................... .~..~' 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 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 ............................ If garage, number of cars ................................................................................................................... ~ ............... .-,.... ..... 6. If business, commercial or mixed occupancy, specify nature and extent/of/each ~pe of use ............................ 7. Dimensions~istingstructures, ifany: Front.~j..'~....~'... ...............Rear ...~.....~..'. ...................... Depth ~....'3,~..i ........... Height .....~.6~-- .......... Number of Stories ..... ~. ........................................... ,,,,'7 ............................. ~ .......... .~/Y ................. Dimensions aflame structure with alterations or additions: Front .... ~1~..~.... ....................... Rear . .~'.,~... ................... Depth ...~...~... ..................... Height ...J/.J~.... ............... Number of Stories ..../ ......................... 8. Dimensions of entire new construction: Front ....~.../.. ......................... Rear // .../.. ..................... Depth ........................ Height ...../~.~ ...... Number of Stories ....... ./.. ........................................................................................................... 9. Size of lot: Front ...../..~'~'- ~ . ._Rear .... ./.~.. ................ Depth ./.Z..O.. ..................... - 10. Date of Purchase ,,,,~./........,...~.. ..........~..,w..., ........ Name of Former Owner l~.~.''~:..~.,~'..,l.l.'~'. ...................... ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constru~z-~nJ~g law, ordinance or regulation? ..:. ...................................................... ]3. Na me of ~mises ~*/.~..' '~"..~ ~..~...5..~'.~.Address ~....~.~..~, .~. K-.. ~ ~..~/,4~..~,~one No. 7.~.~.~Z~ ~ Name df Architect ...................................................... Address ............................................ Phone No ..................... Na~e of Contractor ..~'~...~.~..~-~....~.~...~....~.( ....... 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 block number or description according to deed, and show street names and indicate whether interior or comer lot. N I STATE OF NEW/~OP~, .~ · ! ~ ~ ,COUNTY Of ,~(i~l~.,~.----....)'~'~' ...... /..*~<'.~.~..,~.~-.'..~..~-~.~-~.'~.~....<~....~/~ /'~'~"- .............................. being duly sworn, deposes and says that he is the applicant ! (Name of individual signing aPplicatio~n) . above named. He is the .., .................... ~....r.~..~../.~.~./'~ ..................................................................... i~.......Li ..................... (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 oil 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. Swam to before me this ................ · I..z.. day of ........... ,~..,j.~. ............., Notary Pu Ii .. E[IZABETH ANN I~OTARY PUBLIC, State of New Yorl~ suf,o, ~1'1r~1 Expires March 30, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Temporarl~ Certificate Of Occupancy No. S .~?~;1 .. Date THIS CERTIFIES that the building located at Map No. Peo. Homos Block No.. Lot No. 8 Peconie lo ., z9 7o Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Dee . 8.., , 19 (~9 pursuant to which Building Permit No, ~.9,(~. dated .. llec~ .. 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 P~.$V,~.~.9.0.~e..fSa~.i.t.~r..d.'~.~..]..il~..~ ......................... The certificate is issued totn. ge...C~.au.~n. ..... . .O,fm.e.r..- .butld..er.. . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..................... mmse ~