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Home My WebLink About4404-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPAI~TMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~89~. ..... Date ................ .~. ~.....8...., 19...~. THIS CERTIFIES that the building located at(R o0 .I~.)..Pgt~l. ~..~8....1~/ .... SounclstreetAVe Map No .... ~z ...... Block No...z~ ..... Lot No.. ~xx .... Mai;titu~k...1~.,¥, ...... conforms substant~aily to the Application for Building Permit heretofore ~ed in this office dated ............ De~..28.., 19.67. pursuant to which Building Permit Nu~lli0~Z .... dated ........... Dee. -.28 .... , 19. ~>7, was issued, and conforms to all of the require- menus of the applicable provisions of the law. The occupancy for which this certificate is issued is . PriYate .one. ~a~i.~.y. cl~.eLling ....................................... The certificate is issued to ... J~tm. It, .Lea .... Jitney. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. P~y...~... f ~.~.1~.. b~ .B...V.~ll& ... UNDERWRITERS CERTIFICATE No. ~ 1~..~3~98.~ ..... J. an...~...~.97~ ............. HOUSE NUMBER... 2.7-$~ ...... Street .... Pr.~-va%e..Roa~l..~. ~ 1~..Ea~.~;ttuck .... ........ ...... FOF~I NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. z]0 l Z Permission is hereby granted to: to .......... .i~u! 3~1... ne~...m3e...£~3,~.. ~;~ ~g .......... on.,.~t..2 ............................................ at premises located at ................... ~,~J,~.~.....JJ~....]~Ll~..J~Jr,~ ....... &..l~;J'...~.....J411gJ~. &~'e ...................................... .l~at.~;~l~ ...... .II~Z. ................................................................................... pursuan~ to application dated ............................. JJ~.JJJ.....2JJ.., 19.~..., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUI'HOLD, N. Y. Application No ................ ~ ....... APPLICATION FOR BUILDING PERMIT Date ..D..~...C....~.'~...~..~.~..~. ....... .~....~.. ....... , 19....~....~.... INSTRUCTIONS · a'. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building It~speetor. b. Plot plan showing Iocabon of lot and of buddings on premises, relahonsh~p to adloming 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. 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 qf the work. 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. APPLIC_~TION 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 of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, I~uilding cede, housing cede, and regulations. . ............. ...................................... (Si~['~%f ~plicant, mr'~ame, if a co~ra~'ion) '" 2 E' 1..-..~.?~ ...~. x'. Z,.4.~./.~..~......,~...~......~..~..~.c..~ ~ .,..~ ~.....~..~.,. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ..o.. ................................................... ................. :: ................................................................... Name of owner of premises ....... .~....O.....~....~........I~/:....L....~..~. .................... , ................................................................................. If applicant is a corporate, signature of duly authorized officer. x~,x/- '~/2-~ ~ (Name and title of corporate officer) /~,/,~e~ ~ 1. Location of land on which proposed work will be done. JVtap No.: ........................................ Lot No.: ........................ Street and Number ......... ~,..~...U.~./~..L ......... ./~..~.~ ................................. .../?..~....~.....T.~'...~/'.....~..~...~.. ........................... /~'/~ ~ ~/.~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... ~...~L..C..~...~'...?.......~.~I..~...D.. ......................................................................... b. Intended use and occupancy ........... L.....~....~..../~I..~...(.~.. ....... ~..o....e...~..E.. ................................................................. 3. Nature of work (check which li~: New Building ......~.. .......... A ion .................. Alteration .................. Repair .................. a .._Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... .'~.....{ll~.°...~....~. .................................. Fee .~ .............. .~.../..~. ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .O....4(...E. ............ Number of dwelling units on each floor ...~....,~...L-.T. ............. If garage, number of cars ...................... D../~.~.. ....... : ..................................................................................... ~ .............. 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ..~...~ .................... Rear ..... ..~..?.. ................ Depth ...:Z,<~ .............. Height ....~...~. ......... Number of Stories ......... .Z.. .......................................................................................................... 9. Size of lot: Front ........ ~.~. .............. Rear ......... ~...~ .................... Depth ....... ..~.S'..~. ............... 10. Date of Purchase ......... ~...°..Es....z..~.a..I..~...~..7... ............... Name of Former Owner .~JA~...~'...{~..L-..~....~.../~.....c..~../~/.....u...A~..~I..~.~ 1 I. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ............................................................ .~.~./.:~..~....H..!.~.L~.:./?...~....~.y.{; Phone No. J~..[.2.~..~..~..~ 13. Name of Owner of premises ...~.....°...~...'~........l~..:....~..~..~.....Address - . - ~ ~z Name of Architect ....~.~..o...~.....~.?..~.E..~.....7.~/.~.~,. .......... Address .L~.[Y...~..~..~..[l.O./~..~'.{.E.~...~J~Phone No..~...0...../.'.~.~...3:. o Name of Contractor ..... .~..?..H...AX'........I~..:....L:...~...E. ............. Address~..~;..!.?.~..~....~.i;.L-..c.~...~J.¥~. Ph~n~ No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i'nterior or corner lot. ~ 5-I STATE OF NEW ~OR~, ~¢ c COUNTY OF .... f~ k/. ~..~. >.;k ......... ~'~' ................ .'~...~..t'~ ................. ~v..~ ............................................ being duly sworn, deposes end seys that he is the ~pplicant (N~me of individual signing application) above named. He is the ........... ~.~.~.~.~ ....................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~:ke and file this application; that all statements contaj~d~in ~is agRlicati~n~re true to the best of his knowledge and belief; and that the work wdl be performed in the men'Er set foffh ~ the a~phcatlon fded therewith. Swam to before me this / ....... ......... day of ....... ~.~.~.: ........................ , 19.~.~... ~ ~ ~ ~ ~ p b,c, .......... ............................. THE NEW YORK BOARD OF FIRE UNDERWRITERS ' BUREAU OF ELECTRICITY 88 JOHN STREET, NEW YORK, NEW YORK 10038 DateJa,~ ,ar, lti, THIS CERTIFIES THAT in the followlng location; [] Basement [] 1st FI. was examined on January ll, ] 97~I ~2nd FI. Outside Section Block and found to be in compliance with the require~nents of this Board. RANGES COOKING DECKS ~)VENS DISH WASHERS FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENT DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: ~Sp~'cia! r,~:~pt, acles: ~!o~o~'/s: !-l/2hp E R NO. OF CC. COND PER ~Er 1 OF CC. COND. il/0 C NO. OF HI-LEG OF HI-LEG NO. OF NEUTRALS OF NEUTRAL 2/O A:'thur W. Lee, 2;4g West 8th St., Deer Park, L.I. 11725 Per ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. LAuReL TO'~'t--I Of- !"~DI...rT'I'IOI-ID, ~"Y" '=SC/X,,I-b ° 40~= I"