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Home My WebLink About5345-zFORM NO. 4 TOWN OF $OUTHOLD BUII,DI~G DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.z~'t~j~.... ..... Date ..........Sepf~mber..ll~e..., 19.23 THIS CERTIFIES that the building located at .. ,~ern~k. Lane ........... Street Map No... ~'~7 ..... Block No. ~ .x'/ ...... Lot No.. 2~ .......$o-thold ............ conforms substantially to the Application for Building Pemit heretofore filed in this office dated ........Jur~e- 10t ..... , 19 .?1. pursuant to which Building Permit No .... ~.~Z dated ........Jtme.lOs. ....., 19.7l., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .Renet4. J.,. -¥ecl~o~lt~h=~ g ........................... (owner, lessee or tenant) of the aforesaid building. SuffOlk County Department of Health Approval ... Tempora~r. C,.0,. ~1 .£11e ...... UNDERWRITERS CERTIFICATE No..Te~p.~rar~..~,0.,..~. ~.~le ................. HOUSE NUMBER. ~ ......... Street .. J. el~l~. ~ ......................... .................................................. ~.~h. vl.~ .................... BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ·UNTIL FULL COMPLETION OF THeE WORK AUTHORIZED) Permission' is he!i~by :granted to: ~"'~ ~ ':i'-,:~',.pursu~,t to opp'tfcation dated .......................... ~1;[1~1 ....... .~- ........... , 19..,~1~, and approved by the FOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~.~.~.~. ..... Date ............ Ma~ ..... ~ ...., 19.~ THIS CERTIFIES that the building located at JOl'l~tOk '~- .. · Street Map No. l~l~t · lll~ck No ........... Lot No.. ~S~... 8~l~ll[ ................ conforms substantially to the Application for Building Permit heretofore filed I.'n this office dated .......... ~lul~e - - ]0.., 19~. pursuant to which Building Permit No. dated ............ ,$11~e.--~0., 19.~]., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .. R~&ld .¥e~leutsehn~g ...... Oenet, ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval "K&I" 2~ '~'~2'' b~ 'R~' ~X& .... 80~ ~F~.g~S Path ..... ~i ing ~nspector I THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ab BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK. NEW YoRK 10038 THIS CE~IFIES THAT Ronald Yedloutschnig, Jernick Lane, Bet. WellsAve. & Oaklawn Ave., S~ut hold ~L, I ~. in t~ follo~ing ~atio.; ~ B~e~nt ~ Ist FL ~ 2~ FL Outside ~io. a~k ~t ~..~o. Sept.~e~ 1~, 1973 a~fou~to~incompliance~iththerequire~ntsofth~B~rd. FIXTURE /~A I WIT H I EXTURES I ~36 ! '~6 2~ 36 ~._.~T&..~4~. W. OIL N.P. OAS H.P. A/~T. NO. A.W.O. RANGES COOKING DECKS OVENS I DISH WASHEIi~ ,T. K.w, I~T./ K.w. ~,T. ~.w. I1 T~C~KS ] BE~ lUNnHEATm MUL~UT~T SERVICE DISCONNECT 1 200 CB OTHER APPARATUS: S R V I C E ,~EI~. I.~2W 1~3W 8,~ 3W 3A' 4W NO. OF CC. CONO,.. "l EXHAUST FANS DIMMERS OF CC. COND. 3/0 3/0 W~ter Heater] 1-4. 5KW Post llght Eleotrlo Room Heaters] 3-2.5KW q-2.0KW 1-1.,SKW 2-1.2~KW 1-1.0KW 2-.~KW Peter Mikiciak 26 Circle Drive Jamesport, L.I.119~? COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da~e March 2~ 19~,2 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewase disposal facilities for a structure located at ~ap c~ Ha~ves% H~es Es~tes~ Sec. 1~ ~t ~ Je~ck ~e~ 3~0' ~ ~ Ave., (Give deed loca~ion) ~u~old have been inspected by this department and found to be satisfactory. MAR 2 '1972 C~ef o'f General Engineering Services Examined J4o,.A.&. t 0 Approved ........................................ , ? FORM NO. I ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........Pemlt No ..................................... Disapproved o/c ....~. .................................................... ~/_.~_-m.~,~ ('~'"~~ " ............... ~...,~ .......... ~ ...... : ........ ~ .......................... .~.~ ~ ~ / ' .............. ........ , .... . 's app 'cot'on must be completaly filled i~ b~ kpewriter or i~ ink and submitted in duplicate to the Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drown on the diagram which ~ port of this opplicotion.~4 C_ 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 o ]~uilding Permit to the applicant. Such permit_'{ shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. "- -APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 oll applicable lows, ordinances, building code, housing code, and regulations. ignatu~ of appl~fant, or name, if a corp(~ation) ............... (Address of applicant) ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .....'~x4F.4~.....,,~.,..~...~.P~.~ ./.~.c~..~..(~ .................................................................................... If applicant is o corporate, signature of duly authorized officer. '~ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...~.i,~....~....~.. ......................... Lot No...~-. .................. ~. Street and Number .......... ~.~.~.4'Y.~(~<....~...,~.~..~. .............................................. ..--~..~.T..ff~4,~. .................. : ....................... 'Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ ~'..~...~...~..~...~.. ...... ~..T.. .......................................................................................... b. Intended use and occupancy ...... .~.Z. .~..~ .... ~ .... .~.~..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 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 N b f Stoie ~ ............................................................ um er o r s ................................ 8. Dimensions of entire new construction: Front ......... .~...~.. ................... P, eor ..... ~..~'. ................. Depth ....~.~. ............... Height .................... Number of Stories ............~ .~,....~c~.. ...................................... ~ ............................................ 9. Size of lot: Front ...,~,~..O.~..~ .......... Rear ..... /.~.~.,.~...o. ................ Depth ......... /..~..~...~ ............. 10. Date of Purchase ....x~.,'~-.~'././.~.~.,~ ...................... Name of Former Owner ..~..~./.;.....~4~./.~.~..~/.~. ........... 11. Zone or use district in which premises are situated ...~,..r~..4~...c..~. ......................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ...... ,L)...Q ................................ 13. Name of Owner of premises..~..-.~...~xt+N..,sr, sxaw~.'/~....Address..~.~..~W.~'~,~.~.~..~.~..~.P. ...... Phone No. ~fi47;.~..o..(~. .... Name of Architect ................................................... ;..Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No: .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to d~ed, and show street names and indicate whether intelrior or corier lot. STATE OF NEW YORK, COUNTY OF ....S.~t~C~3J~, ........... ..................... ~..{~tl..~e~U,D. tz~,~l, cJ3.1ij.g ................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named]~te is the .......................................................... g~'3~; ................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to me.ke 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. before me this Swomt~otl~o day of . ~Llne .. o , 19.T~1. ...................... ' Notary Publi~.f~/~gZ~.~.. CountyO~BU~ol]c (Signatt~e ~;~'~ .......... ~ .............. ELIZABETH AN~ NEVILLE . NOTARY PUBLIC, S~a{e of New Yo~k No. 52-$12~1, ~dfolk County_