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Home My WebLink About6128-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ¢.~.9. ! THIS CERTIFIES that the building located at . Kain. ~-.W. l~ad. F...I Map No. F.I.~st ............ moc~ ~o ........... ~o~o ...... Fl~ers..tsar. -N.~, .... conforms substantially to the Application for Building Permit heretofore filed in t~s office dated .......... Sept .... ] ~., 19 .~2. p~suant to Which B~l~ng Pemit No. 6128~ · dated ............. Sep.t.. 2~, 19.72., was issued, ~d conforms to ~I of the requffe- ments of the applicable pro~sio~ of the law. The occupancy for which this certificate issued is . .Accessory. g~st. cottage... (a~itl~.&. ~t) .................... The certificate is issued to . Joa~ .B.. ~tes ........ ~er .......................... (owner, les'see or ten~t) of the aforesaid building. Suffolk County Department of Health Approval ...N..~ ~ ....... . .................... UNDERWRITERS CERTIFICATE No. pendi~ .................................... HOUSE NUMBER .............. Street .......................................... .... t..U~ ..... . ..~ . ....~..~ ...... B~d~g ~spector · 0~ 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? 6128 Z Permission is hereby granted to: .... .&~.~..~f~l~.G~n~..~xtr..A~..~eau 2, Ga'~s ................ ..r. L,.~..o.~..,....z..,..z. ~ .............................. at premises located at ..~oz~s~...el~t~..e~..~eur..G~e.~L.p~'~m~ael.t ................................. ....................... ~ .~......~...%L~...r~.~ ............... ~J,m~e~.l..~,~l~z~.....l~.,~, .................................. pursuant to application dated .......................... ~..~.~t~......~.6 .......... , 19~1~,..., end approved by the Building Inspector. Fee $.~.0,~.~0. ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Disapproved a/c .................................................. ~ ........ ................. ~/---- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building 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 of property must be drawn en the diagram which is 1~3rt of thio 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. e. No building st~311 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. APPLICATION 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, building code, housing code, and regulations. (Signature cf applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~...~To~..Bo..I3&~,,~I .................................................................................................... If <applicant is a corporate, s!gnature of duly authorized officer. Location of land on Which proposed work will be done. ]~Aap No.: BM..~I.a~,..~I~ ......... Lot No.: ........................ Street and k'umber~-9~C°c'~L~'~j~-/~-~ - ~-~) ~;~-"~-A~/ /~r~ ~ /, Municil:x31ity State existing use a.nd occupancy of premises and intended use and occupancy of proposed construction: Existing ..... ....................... 77 ............ ....................................... use occupancy b. Intended use and occupant', ...~al~{~,..~.. ......................................... .~; ............. ~ ....... ;, ................................. 3. Nature of work (check which applicable): New Building ~ ................. Addition ....Jg. ........... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........$~1~.000o~0 ............................ Fee ....~,'l,~lO .......................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ...... 1 .................... 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. D,mensions of existing s~ructures, if any: Front ........~.~.~. ............ Rear ........ ~J.~.. ................. Depth ....~..~...~...: ...... Height .....15! ............. Number of Stories .............~, ................................................................ Dimensions of same structure with alterations or additions: Front .... ....... ~* ................... Rear ........ Depth ...~..~2 ..................... Height ......~.~ .................. Number of Stories ....... ~, ...................... 8. Dimensions of entire new construction: Front ......... 1.&! ..................... Rear ....... ,~.&.e. .............. Depth ....~,.~.~. ............ Height .....~.5..~. ........ Number of Stories .......... ~, ......................................... 9. Size of lot: Frant~...~l~...~].a~,ear .................................... Depth ................................ 10. Date of Purchase ....... ~ ................................Name of Former Owner ~t~l~J~l~l....~..l~..~..i~.d.....~?..?.....C~.....L?~, 11. Zone or use district in which premises are situated ........... ~llla,~nt~,;La~. ............................................................... 12.; Does proposed construction violate.any :zoning law, ordinance or regulation? ........ lal~ ................................. 13. Name of Owner of premises ~To~I~..~..I&~.~ ........ Address ~t~3~l,g~ia ~l,~, ..... Phone No ~.~l...-..~..g....3~... Name of Architect ..... ~O~ ....................................... Address ............................................ Phone No ..................... Name of Contractor~,o~o..Iga~l~.lJmt:o...CoJJJ',~',...Address ~';L~...;7~,~1~I~1, ......... Phone No..?..8...~..?...2..3..~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex sting or proposed, and ndicate all ~et-back dimer~ions 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, tee COUNTY OF ................................ (Name of individual signing al~pllcatlon) above named· He is the ......................... CeI~Z'~:.O~. ......................... ~ ..................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hav~ performed the said work and to make and file this a. pplication;..t.hat all. state,re, ants contained in .this applicatidri'. are.~th~ t° the best of h s knowledge and belief; and that the work win De perrorrnea in the manner set torth in the application filed therewith. Sworn to before me this ~. _ ~ 'ta ................ . .......... ........ ......... mo ry bi'c, ~...~ ........ :; ...... County ~/ ' (SignatuTM of applicant)(/ ............. ~ot~l'~ Public, State of New ~8~[ding in SuffeJk Co. Off. No. 52-643900G THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY .,.. A.;..c 3'~E ~973 .,,.,.,,,,,,~,,. No. o,,,.,,~.,.0.,.'., N 11'2467 THIS CERTIFIES THAT only the e/ect ,r/ca/equ~prne~ a~d~scHb~ belq~_ ~ iD[rodu~.bl~oi~t~O~O~ed ~ t~ above application number ~n thepr~mises of in the following location; [] Basement ~ lst Fl. [] 2nd Fl. Outside Section Block Lot ,~=sex.m;nedo. AUgUSt ~.~-- ]-97~ and found to be in compliance with the requirements of thls Board. RXTURE / EPTA I I RXTURES OUT.TS c,.SlSW.. . ,o~DTRYER:w. lo,t FUR~pA. CET~sTORSHp I mTj~APPU~o~EN~Lq~w~:' RANGES SI~CIAL REC'PT, SERVICE DISCONNECT I bio. OF I S I 100 MCB X OTHER APPARATUS: E R I¢OC)KING~KSl OVENS I mSH WASHERS A~T. K. W, Ii AMT. K.W. MT. K, W. TIME CLOCKS BELt UNIT HEATERS MuLTI-OUTLET V I C E EXHAUST FANS DIMMERS OF CC. COND. 2 A.W-G. NO. OF NEU~TRAJ~, A.W.G. OF HI-LEG Of NEUIRAL A. John Gada ContractingE Inc. Drawer B Fishers Islaad, N_ Y. 06390 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.