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Home My WebLink About5010-zFORM NO. 4 TOWN OF $OUTHOLD BU~r.~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z5673 Date NoV 29 19 73 THIS CERTIFIES that the building located at . .H..u~.t..i.n.g.t.o..n..B.l.v..d ......... Street 1~, . Peconic Sh, ap l~o ............. ~ioc~ mo ...........Lot No. 73~?!+'75 Peconic N.Y. confoms substantially to the Application for Building Pemit heretofore fried/n this office dated Oct 19 19.70 ...................... , ... pursuant to which Building Permit No. ~010Z Oct 19, 19 70 dated ........................... , was issued, and conforms to ail of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is Private one family dwelling with addition (garage) The certificate is issued to Victor L'Eplattenier Owner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N .R. N.Ro UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ~+% Street Huntington Blvd Building Inspector/ FORM NO. TOWN Or sOuT.o , BUILDING DEPARTMENT TOWN CLERK'S ~UTHOLD, N. BUILDING PEIUVtlT (THIS PERMIT MUST BE KEPT ON THE PREMiSE~ COMPL[TION OF THE WORK AUTNORIZED) !' UNTIL FULL Permission is hereby granted to: · ~, pursuan,t to application dated ............................ ~, ~?-,,-,,.]~.t.,.: ~,.., 19.~:~: ,a~d,, approved by the Building Inspector. , :~:,, Fee ~ .............., ' ~ ' ~ ' ' ~,~ ....~...zg..... ,~.7~. ~ ~~ ~,,~,,o~ ,o' ~.l~.~.. ........................................ , 19 ........ Permit No...~.~L~..~.. ~ll ,~fi ............................... ~e-~*~ ~ A~FLI~TIOg FOR IUILDINO FE~I~ ~t~ ........................................................... , 19 .... INSTRUCTIONS o. Thi~ applicoti~ must be c~pletely fill~ in by ~ewrit~r or in ink und submitted In ~pll;~ b. Pl~ plan s~ing I~ation of lot o~ of building~ on premiss, r~lation~ip to adjolnl~ pmm~ or ar~s, a~ givl~ a d~oiled ~ri~l~ of I~t of pm~ must ~ drown on the diatom ~ It ~ of c. ~e Work c~er~ by this oppilcati~ may not b~ commenced bafom i~uo~t of Bulldl~ Pe~lt. d. Up~ ~r~ol of this appllc~ion, the Butlding Ins~ctor will I~ue · Bulldl~ Pe~lt ~ th~ ~pll;ont. ~all I~ k~t ~ the promises ~llable for inspection throughout the p~ress of the wo~. e. No bulldi~ s~ll ~ ~cupled or u~d in whole or in pa~ for any pu~e ~ate~r until a Cefflflca~ shall h~ ~en gmnt~ by the Building In~r. APPLI~TION IS ~REBY ~DE to ~e Building Pediment for the issuance of a Building Permit Building Z~e O~inance of the T~ of ~thold, Suf~lk Count, New York, ond other ~llcable ~ ~lm~ R~ulatl~s, for the construction of bulldl~s, additions or al?rations, or for mm~al or demolition, al heroin ~rl~. ~e applicant ~rees to comply with all applicable laws, ordinances, building c~e, h~slng c~e, and ............. ............. (Signature cf applicant, o~me, If a ~1~) ..... (~dress or a~llcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... o..~.,~ ................................................................................................................................................................ Name of owner of premlm ...~'/.~..: .... ~27.~.~. ................................................................... If applicant Is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) ,. L=t,on o, ,and on wh,ch p pes..' w,,,. do... Mop No.: ............. st.. and Numb,r ~Z~ ...... ~/~.~.....~,.Z~.~ .......... ~ .~.~..~.O~.../...C., ..................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of pmpmed coratructlon: a. Existing use and occupancy ...Z~iX~,~....~.e.~.~.~A~..~./,..~.~.~.*q...~.....7. .................................................... b. ~nte.ded use and oc~upo.:', ......'~/.~a~'~..~.~.~'.~...:..~.X~.~......~.C~.~.....~.~...~..~ ........................ 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 fi!lng this application) 5. If dwelllng, number of dwelling units ........................... Number of dwelling units on each floor ...................... If garage, number of cars . e~......~..~....~... ............................................................................................................ ~ 6. If busine~, commercial or mixed occupancy, .~ecify nature and extent of each type of use ..~../.~.. ............... 7. Dimensions of existing structures, if any: Front ...G~....~... ............... Rear ....m~.~.. .................. Depth ~.. O Height ..~.: ................. :. Number of Stories ...... /. .................................................................................... Dimensions of some structure with alterations or additions: Front ...~...~... ...................... Rear ...~......~.. ........... Depth ....~.~. .................... Height ............................ Number of Stories ..... /.. ....................... 8. Dimensions of entire new construction: Front ..,~.~.. ........................Rear .~./'~.. .................. Depth .m~..~. ............... Height .................... ,Nu~m~ber of Stories ...../.. ............................................................................................................. 9. Size of lot: Front ..../.~?;..~. ............ Rear ..../....~.....~... ............... Depth ....~..~...~.. .............. 10. Date of Purchase ....~'~.....: ............................... Name of Former Owner ..../~.....'~..~.......~.~",V~.'~.... ............... 11. Zone or use district in which premises are situated ..... v~..~'/..~...~./..~....~. ............................................................... 12. Does proposed construct[an violate any zoning law, ordinance or regulation? ...~..~ ............................................... 13. Nome of Owner of premises~.~......~...c2~.8~...~../.~./~..~..~:d~ress .,~.,¢~/.~.z-.~...~..,~..~.~...e~.:.... Phone No. ~...~.~..':...?./.<~' Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........... ,,.~O.,/2'~4~. ........................ Address ............................................ Phone No .................... PLOT DIAGRAM Locate Clea.rly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properh/ lines. Give street and 'block number or description according to deed, and show street names and ind/igate whether interior or comer lot. /t. fflS, q/,~ 407£ o STATE OF NEWk~R,I~ .,.~..~ tee COUNTY OF ........ __. (Name of individual signing application) above named. He is the ................................. ~ .............................................. JL ....................................................... (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: that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ....... ,..__-,, ...... ....... =... ....... .... /~ ELIZABETH ~IN NEV~.LE . ' v NOTARY PUBLIC. ~tate of/New .~,. 52.8125~0, Sullolt Cot~ ~rm .Expire~ ~arch 30,