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Home My WebLink About4302-zFOR~ NO. 4 TOWN OF SOUTHOLD: BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. kI .35.4.9. .... Date ...... . J. uly ..... 14~ ........ , 1969.. THIS CERTIFIES that the building located at L:~Vto i Rd. l(toOse, il:ack)... Street Map No ............. Block No ........... Lot No ................................. conforms substantially to the Applicaion for Building Pem~it heretofore filed in this office dated ..... ~ay ..... 22., ..... , 19.69. pursuant to which Building Permit No. il02. Z.. dated ..... ~ay ..... 22., ......, 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~.ivat~..one..lamaS. ~.ellag. ....... ............................. The certificate is issued to ....... .~llen .L,. P:lce ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... House ~ 1195 Goose C~eek Lane FORM NO. 2 TOWN OF $OUTNO£D BUILDII~G DEPARTMEH? TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4302 Z Permission is hereby granted to: a.,...~;l~.~..a./c ....... ~!,l,,,a..,~e~ ........ ........... ~..o..a.~.o. z¢.. ............................... ~ ................. pursuan¢ to application dated ............................. ..~..~. ......... ,,,'~-.......,., 19......~.., and approved by the Building Inspector. Fee $ ~,~00 Building Inspector FOKM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved * ' '" , ............... ;: ....................... 19....'/... Permit No....!,~..~:.~...w......~... Application No. Disapproved o/c ........................................................................................... ~.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~/~.., .~,. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ihk 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 decailed description of layout of property must be drawn 6n the diagcam which is part of this application. c. The work covered by this application may not be commenced before issuence 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 prOgre~Ss of the work. e. No building shall be occupied or used in whole or in part for any pu~'pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the is~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and other applicable Laws Ordin.ances or Regulations, for the construction of buildings, additions or alterations, or,removal or demolition, as herein described. The applicant agrees to cdmply with all applicable laws, ordinances/,b.~_ldtn~ code and/regulations· ......... ........................... ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder. .......................................................... ............................................................................................................ Name of owner of premises ........ ~-.'.'.~.~,~.':~ ...... .~, .................. ,.~-~..~./..(.-.~:' ................................................................... 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.: ........................ N u mbe r/~.,/~,,~.~.....~,.~ .~ .~ Street and ....... . .~. ~.~4'~.,, ..(~ .~ ~. ~ · ,~r...,~.. ,(~r~...,. ~ ............. ......................... Mpnicipality 2. State existing use and occupancy of premises and intended use and occupancy,of proposed construction: Existing use and occupancy ............ /._.~ ..../.~. .............: .......................................................... b. Intended use and occupancy ............... ../. _~.../.~,.,9./.(.~. ........... 3. Nature of work (check which applic Repair .................. Removal ......... 4. Estimated Cost ............. ~....~..i..~..~..~.. 5. If dwelling, number of dwelling uni If garage, number of cars ................ 6. If business, commercial or mixed 7. Dimensions of existing structures, if Height ...... ./(~. ............ Number of Dimensions of same structure with Depth .......~ ................... Height 8. Dimensions of entire new constructi .....t.~.'~...__ ..... Number of St( Height 9. Size of lot: Front ....... .'~._~... 10. Date of Purchase ...........----"~/"~"~"; ~ 1. Zone or use district in which premi,, 12. Does proposed construction violate 13. Name of Owner of premises~"~,4 Name of Architect ......................... Name of Contractor/~r. Locate clearly and distinctly ali build property lines. Give street and block nu whether interior or corner lot. STATE OF NEW ~'ORI~ i }, ~ COUNTy OF ..~ .......... ~'b' ....... ....... ./ (Name of ir~diwT:J~aJ/signij//g appl above named. He is the ........................... of said owner or owners, and is duly autF this application; that nil statements cont. that the work will be performed iH the ma~ Sworn to before me this .... ~_~)..~.....~..... day of ......... Notary Public, ]ble): New Building .................. Addition ...... ~ ..... Alteration .................. ........ Demolition .................. Other Work (Describe) ........................................ ..........................Fee ........................................................................................., (to be paid on filing this application) ......... .J. ................. Number of dwelling units on each floor ............................ occupancy, specify nature and extent of each type of use .............. ~ ............. . ny: Front ...../~. ................. Rear ...... .~.~.~.. .................. Depth ........~... ........ ~tories ....... ~ ........................................................................................................ ~.lterations or additions: Front .....4,/¢'~,~ ........................ Rear ...~.,;t .................. ..../(~ ................. Number of Stories ........... ~ .................. ~n: Front ........ ~:a ........................ Rear ..... .~ .................. Depth .~.~ .............. ries ............... ~ .............................. ; ..................................................................... ~ear .............. ..~.? .............. Depth ........ ,.~-.~1 .......... /..,,,~.~.~ ................ Name of Former Owner ....~.Zz~-~,~.~ ...... ..~1~.~.,~,~;.~:.; .......... are situated .............. ~.~, ~,,~ ?.~.~u,,,~ ;~.,v. ~ .......................................................... :ny zoning law, ordinance or regulotio ........................ ~)c~'...~:.:../~Address ,¢~.~.,-~-~,.~...~.¢~.~.~.,...~z~-,C~'~l;~bene~ ............................ Address ............................................ Phone No ..................... I;~'i¢'~;f .............. Address .~.fz,:....~.~.6 ........... Phone PLOT DIAGRAM ings, whether existing or proposed, and indicate all set-back dimensions from '~ber or description according to deed, and show street names and indicate ............................ being duly sworn, deposes ond says that he is the applicont cotion) (Contractor, agent, corpora[e officer, etc.) orized to perform or have performed the soid work. end to make and file ined in this application are~,.¢~,~(o the best of his knowledge and belief; and mer set forth in the app~on~kd therew~h. ...... :....;,..., , ¢ ......................... ~o. 52-8]25850, Suffolk [errn Expires March 30,