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Home My WebLink About5616-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Soutbold, N. Y. Certificate Of Occupancy No..~.1~.~..2.. .. Date ....... ~xl].~'. .27 , 19.72 THIS CERTIFIES that the building located at · Iielax'y .~lle &. ~ a~,ATe ~Street Map N~e~ic HO~ock No. ~eg. ~.~ ..Lot No. ~. .. PeCo~C ~ ,~, .... conforms substantially to the Application for Bulldog Permit heretofore filed in this office dated -. -~eV. . ~., 19.7~ pursuant to which B~lding Permit No. .~1~. dated ......... ~;~v .... ~..., 19.~., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Priv~tc..ome..g~m~l}~ -~wetl~g .................................. The certificate is issued to gumes X'eo~os ........ 6~e~ .................... (owner, lessee or tenant) of the afores~d building. Suffolk County Department of Health ApprovM July' · ~'$ · · ~ 972' b~* .R ~. Villa ...... UNDERWRITERS CERTIFICATE No..~. 332~ ...................................... HOUSE NUMBER.] ~ % .... Street...H~nr.y .~nO ............................... 1 Bmlding Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5616 Z Permission is hereby'granted to: ..~.~e,~__~.,..-C.e~q~,.....,~/~..~_,,~ee-. .......... ~....-~,~a~,~...~,,~, ............................. to ..;~ ..a~...~a~..~r~i~...~ ~ ................................................................................. ot p~m~ses f~:oted ot ...... let..~.....~e.,...Z/ ....... l~,~em~l~..~ ......................................... ...................... : ............ ~..;/,a:.&..~, ..,~o~xua...~m~.. &ye ~ .......... ~m~ ............................ pursuant to application do~ed ................................. ~ ....... ~1~ ....... , 19...~:~., and approYed by the Building lr~pector. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [--- ad B5 JOHN STREET, NEW YORK. NEW YORK 10038 ..,e .Tuly 24 1912 ~p~,,~otio.,~o.o.:.le 561892N 33241 THIS CERTIFIES THAT ~' only the electrlr~d qquiprrAent as tlescrlbed,be[o_w a,r~ zntro~lu.c~d~by.t.h~. .app~a~nt~nF~ed ~the e~bo~ ~l~c,~t~Qn~a,,~, m~e~r~ i~n the premises of ~conic, N.Y. inta~/ollo~in~lo~tlo~: [] So~m~nt ~,tm. ~ Z~a r~. outside S~tion Slo~ Lot was examined on July 2 0, 19 ? 2 ond found to be in compliance with the requirements of this Board. fiXTURE / ~' I T | F XTURES RANGES COOKING DECKS OVENS I .D~-~-SH WASHERS EXHAUST FANS~ OUTLETS~E-EPTACLESSWICHES~-C..D~$CE.rFtUO~e$¢~N. ~:~c~Y ~V.T ~w A.vJ KW ~T, KW ,~T KW AMT HP DRYERS FURNACE MOTORS I FUTURE APPLIANCE FEEDERS ISPECIAL REC'PT~ TtMECLOCKS f BI EL {UNIT E SYSTEMS -- OTHER APPARATUS *Furnaces: 1-1/Shp., 1-1/15bp., *Future Appliance Feeders: 1-2#14 2-3#8 Motors: 1-1/2bp., P.O. R)x 1005 r GENE~, /~'~ ~en~t~ls 'i: L. Ronkonkoma, L.I. 11779 ~,~ Pe SCHD SUFFOLK COUNTY DEPARTMENT Date Bids. OF HEALTH Permit NO. TO WHOM IT MAY CONCERN: at The' sewase disposal~ facilities for a structure located ! ' (Oive 'deed~ locati~) have been inspected by this department and found to be satisfactory. 6~nief of General En~ineerinM Services District Engineer JUL 2. 1 ~972 --.,.. APPLICATION FOR BUILDI~ P,ERMIT, 0 ............ .......... ........ ...... T~is ~pplic~tion must be 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 detailed description of layout ofproperb/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 of the work. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy. e. shall have been granted by the Building Inspector. .~ APPLICATION IS HEREBY /v~ADE 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, os herein described. The applicant agrees to comply with all applicable laws, ordinanc?, building ced~housi, ng co~ e, and regulotions. i~i.i.~~~.Z.~i~.~~(signature of applicant~ or name, if a'co~13,c/rg~'ion)l (Address of applicant) If appli/,~gt/Js a corporate, signa, tuAe of~uly authorized officer. ~., 1. Location of land on ,,,hich proposed war~ ~will be done Map No · Lot No Street and Number~.'.'.~x(~.~~......~......~.'~~..~ ....... ?)~ ~' "~ /.5-/~ ~' Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xisiting use and occupancy ........ ~ ............................................................................................... 3. Nature of work (che~k which ap~,,licable):. New Building ~ Addition,.. ................. Alteration .................. Repair .................. Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~....~-OOO~ ~-- ~ /~ .o~ (to be paid on filing this application) 5. If pdwellJng, number of dwelling units ...... ~ ....... Number of dwelling units on each floor~....-, ...................... If garage, number of cars .......................... ~ ............. i .............................. 6. If business, commercial or mixed occupancy, spec/fy 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 Stories 8. Dimensions of entire new ConstrUction: Front .............. ~:~..c~. ............. R~nr (oO n~k ..,....'~....~. .......... Height .......~...~ ........ Number of Stories ...... ~ ................................................................................................. 9. Size of lot: Front ....... /...~.,/ ............. Rear ......... ..'~...I..~.. ................ Depth ........... ..;~.....~....~ ........ 10. Date of Purchase ........................................................ I~o(?e~ of ~rrn~ Owner ........................................................ 11. Zone or use district in which premises are situated ....... ~......~...; ................................................................. 12. Does proposed construct on v o I~te any zon ru3Aaw ord nonce or reau at on;~ /~ ~ 13. Name of Owner of prem see ~...?.~.Address..~...~..J...~...'~.~,¥1~l~i'iiiiiiiiiiiiiiiiiill Name · ...~..~....f,~ ............. Address ....... ~/~.....~ ....................... Phone No.~ ................... of Architect Name of Contractor ~..{4'.~.~.-.........~..~...~......Address ....¥..I..~ .................... Phone N6J..~.~...~...:~:..~.0. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil 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 NEW YORK, ! a~ // · , .......................................... /...~/......b~.. .................. £.../...-~.. ........ ...-/being duly sworn, deposes a~d says that J~te is the applicant above named. He is the .................................................... ~7~-~-~`~TT~`2~~-~-~`~ ............... (Contractor~fl[geat, corporate ~fa'icer, 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 stutements contained in this application are true to the best of his know ejjge and be el; and that the work will be performed in the manner set forth in the application3 fl~d therewith. Sworn to before me this~:::~. ~.~ ~ '~"7/~ ,, ~.~J Notary Public, . ........................................................... County ~ (Signature of applicant) ' :1 ~¢tdo rd