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Home My WebLink About6745-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No..Z629.1 ...... Date ............ ~[a~ ....10 ...... , 19..7.~ THIS CERTIFIES that the building located at . .Lltt~... Ne.ek. Raad ....... Street Map No. 32~.1 ........ Block No ........... Lot No...19 .... Ctttahoga~... N,3[, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Ju~...16 19.7~ pursuant to which Building Permit No .... .6~.~.~3 dated ............. JvJ~y- 20., 19. F'3, 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..o~e..f. amil. y 4w®tl~g. ~$th. an. additio,, .................. The certificate is issued to .. Richard .0liver ..... Owne~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. N...R? ............................. UNDERWRITERS CERTIFICATE No..K.R.. ...................................... HOUSE NUMBER...'.~..7. ~.0.... Street..~. ~..~..~..c~...~...~, .~.., ........... FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6745 Z Date ............... ~T.l,~y .......... :~(~ ................. 19.~.~... Permission is hereby granted to: Rt~lz~,..O~i~r. ................................................. ...... ;1,$ *~t;L® ..l~eo~ .. ~oa4 ................................... ................ C~t, chc~ua .......................................... ~o ...... ~ull~..aa..a~ld£f,%o~.. ~, ~a.~% ~ ..,..ma~...b~..~cl o~e ~ ..aa~...t im~.). ........................ at premiss I~ated at ..... ~t...~ ....... ~..~o~ .................................................................... ....................................... ~..~..~tla..~e~..~ ......... ~a~ .................................. pu~uant to a~li~gtJon dated ..... ;J'] ........ ~ ...... J~y .......... ~ ........ , 19..~., ond appr~ by the Building Inspector. Fee St.- ~.e. OQ ............ /~'~ .uilding ,nspector ~] , TO~VN OF ~OUTHOLD BUII~ING DEI~ARTMENT TOWN a. ERlC'S OFFICE SOUTHOLD, N. Y. Approved 19..~.m~.. Permit No. ~...Z..,.~..,~...~.,,~.... ........... Disapproved a/c~ C ........................ Date ...... .................... INSTRUCTIONS ~,. This application must be completely filled in by typewriter od in ink and submitted in triplicate to the Suilding~:::~ a. Inspector, with 3 sets of plans, accurate 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 areas, and giving a detailed description of layout ofproperty 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. 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 work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy~: shall have been granted by the Building Inspector. APPL~ATION IS HEREBY MADE to the Building Department for the issuance of a Buildt.ng Permit pursuant to the,_ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinanc..es or~. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr,bed. Z~. The al~plicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to~ admit authorized inspectors on premises and in buildings for necessary inspections. ......... i nature of applicant, or name, if' ~'~:~ii~i ........ (Address of d'pplicant) State whether applicant is owner, lessee, agent, archite~t, engineer, genera! contractor, electrician, plumber or builder. Name of owner of premises ...... ~./.~.~xf:.~f~.. ......... :.~..,~./...~..~--.-.-.~...... ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of ~orate officer) Builder's License No ....... .~..~~. .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. M~p No.: .....?......~....~.../. ..................... Lot No..~.~. ................. Street and Number ........... ~.~.~'~2,~ ..~..~l~.~....~.~ ............................................................................................... e~ ~ ~ 0 Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~....~'..~.,e~.~.~,~.........~...o._4~,. .......................................................................... b. Intended use and occupancy ............ ..~..~..~.~ .................................................................................................... 3. Nature of work (check which applicable): New Building ' Addition I~ Alteration Repair .................. Removal .................. Demolition .................... Other Work ....................... L...; ......................... ? Z..~...~ (l~r!ption) 4. Estimated Cast .......................................................... 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 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 .......... ; ................. Number of Stot~ies ........./.. .................... 8. Dimensions of entire new construction: Front .......... .'~....~..i ............. Rear ........ .~...~....~ ........... Depth ....~....~...~ ........... Height ...../...~. ......... Number of Stories ..................................................................................................................... 9. Size of lot: Front .................../...~....~....~ ......................... Rear ........... L~..~.. ................... Depth ..... /....'~..~....: ............. 10. Date of Purchase .............. ;.~ ....................................... Name of Former Owner ...~.../.~,.~.~...~'..........~..~.Z'./Zx~, ............ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~f/.~' .............................................. 13. Will lot be regraded ...... ~.~. ............... Will excess fill be removed fror~ premises: ( ) Yes (,) No 14. Name of Owner of premises ..,/~'C.A~-~..~..~.......~...Z..~...~.~.. Address ..Z.,~..~'.(~..~..~.~--~..~..4Phone No.~..~..-...~...~..~. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, (3nd 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 corner lot. STATE OF NEWt;YORK, ..................... .~..~.¢,x~t~9......O...~..~.;~..,~./~. .................................. being duly sworn, deposes and says t~t he is the applicam (Name of individual signing contrac~ above name. -- (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have per~ormed the said work and to ~ke and file this application; that all statements contained Jn this application are tree to the best of his knowledge and belief; and that the work will be performed Jn the manner set fodh Jn the application fJl~ therewith. Sworn to before me this ~,Y LOU~