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Home My WebLink About6538-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z~)~ ..... Date ...... /~%l~. 29 .......... , 19.23 THIS CERTIFIES that the building located at l/eadaw .Lane ........... Street Map No..M~tt.. Esi; Block No ........... Lot No..~3. · · Ma/tituek...N,Yo. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... May - · '3, 19.73 pursuant to which Building Permit No.. 6~38Z dated ......... Hair. · · · 3-.., 19.73, 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 .. Pviva$,e · one .family. d~llfng. ................................. The certificate is issued to . John. La~®~ .... 0,anae~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . lg.,H. ......... UNDERWRITERS CERTIFICATE No..Ii..1.08813 .... AUg . .1.be .... 11973 ............ HOUSE NUMBER -~O ....... Street .... 14eac],ew. l~l® ......................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6538 Z Permission is hereby granted to: ..)~ ~.. Ab;~;z.. ~.OUt~..~n~ ..... A/G..~ohn_.Lo?ell .......................... l~t~ituok ............................. ko ..~ ~..~...~ ~.~ ~.~ L°..~...°...n....e...x..~ ~.~ ~. .~.w...e. .z...z.~ ...... ,. .................................................. ~t premises located at .... .~.0.~...~ ............ ~..~.$.~,:l;L%~k..~'J;&te, S .................................................... ............................................. .M..~..a..d.q.w.... L .~.~.e. ............. ~t .ti~ck ...................... '. ............................. pursuant to application dated ............................MS_~'. ......... ~ ........ 19~..3..., and approved by the Building Inspector. Fee $."J.~'.~O0. ........... · 0~m' NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMIHT TOWN GLEtK'S OF~FIC:E SOUTHOLD, N. Y. Examined ...... .~..~...~... .......... , 19..~..~... Approved ........................................ , I .. Pemit No .......... Disapproved a/C ......................... .~ ...... ' ' ............... ' CBu~i~'~ ................. APPLIC:ATION FOR IUIL~IN~ INSTRUCTIONS :~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildihg Inspector, withl,9 3 sets of plans, ae=Urete plot plan to scale. Fee according to schedule. ~ 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 des~iption of layout of property must be draWn on diaerem which is part'of this application. ~ c. The work covered by this application may not be commenoed before i~uanee 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 premim available for inspection throughout the work. e, No building shall be occupied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy shall have bee~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depertrnent for the issuance of a Building Permit pursuem to the Building Zora Ordinance of the Town of Southold, Suffotk County, New York, and other a~olicable Laws, Ordinances or Regulations, for the construction c buildings, additions or alterations, or for removal or demolition, as herein del~ibed. 'rlm applicant agrees to comply with all alaglicable law~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for uecesse~y inspections. (Signature of applicant, or name, if a corporation) Nattituek (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ..................................................... .......................................................................................................................... Name of owner of premises ~,o~.l'.D.tr, e.l"l ..................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ..............M~....~..t.....~..s..~. ............... Lot No...~..~. ................. Street and Number ..... J~ta,(Lc~..~,__n__~_~ ........... ,~Lt,~,;L.~.Gg~ ....................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: dwelli~ .............................................. a. Existing use and occupancy ..................... $ ............................................................... b. Intended use and occupancy ..............eele..le-j:~i~..e.~..&d&~.~.~.~ .................................................................. 3. Nature of work (check wh,ch apohcable): New Building ....................... Addition .....1:321; ......... Alteration ....... [.:J:~l:: ' Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ........ ~.~.~.....C~......_+. ................... Fee .....~1.~........0~.. ................................................................. ~., ............ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .1 ........ Number of dwelling un, ts on each floor ......................................... If garage, number of cars ............................. : ............................................ .,. ...................... ~ ........................................ 6. If business, commemial or mixed occuoancy,~spa~ify natu.re and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Del3th ..., ............................... 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 ......... .1~ ........... Rear ..... .1~ .................. Depth ...... ~.J~. ...................... Height .............................................. ,.. Number of Stories ..o~e ................................................................................ 9. Size of lot: Front ............... , ...................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 1..Zone or usa district in which premises are situated ............ .".~...~..~.s..t;.. ...................................................................... 12. 'Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ .................................. , .............. 13. Will lot be regreded ........ ~Q ....................... Will exCeSS fill be removed from premisas: [ ] Yes [ ] No 14. Name of Owner of premises ...,T.oJ31;L.~D.~:a.1.3L .......................................................................................................... (Address) (Phone No.) Name of Architect ................... ~ ................................................................................................................................. (Address) (Phone No.) Name of Contractor ...~l[~..J. la:Lt,~ ................. , ...................................... ~ .................... ~ ...............i ...... (Address) "i~ne Nmi' PLOT DIAG RAM Locate clearlY and distinctly ell buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK.. ) COUNTY OF ...... ,~....1~....~., ,O....~... ............................. ) SS ................. ~Ig.....~,~;J,t;J ............................................................. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract/ · He is the ................................. ~..'l.~-O.~ ........................................................................................................................... ~ ................................. {Contractor, agent, corporate oJ~cer, 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. .......................... 3. ......... day of ................. ~. .............. .......... 19 '~,~. ........~'.~-~~ ~ L---/'~'~./'(/~'0 NOtary Public .......................................... County ~ ....................... f:~.~..~,:~i~l.t~j.' ...................................