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Home My WebLink About6193-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...E/~ .Lova .Lane ...... .... Street Map No.. ~ ........ Block No. ~x ....... Lot No...X~t...14.~.t.t.~u..c]~...~. :y.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 0c.t~ .. 2~..., 19.72 pursuant to which Building Permit No../5193Z · dated .......... Oct...2~ ..... , 1972., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ]].~lsSn.e.:~s. b~J,~,cling .................................................. The certificate is issued to .. E.,A,Ke~,sey. P.~ope2/cles. ~;ae ....... ~l~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~.*~ ~ ............................. UNDERWRITERS CERTIFICATE No... ~q. ~7~.~....Jail.. 23~..~.~7~ .................. HOUSE NUMBER...1.~ ....... Street .... .1.14..0 .... .~..v.~...~, .Xl~ ........................... FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTM£NT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6193 Z Permission is hereby granted to: at premises located at ...~-~.....~e..~F~, ....................................................................................... ..... M,t~.~ ..~.,.~.,. .................................................................... pursuant to application dated .......................~t~ ......... ~. ............ 19.~J~.., and approved by the Building Inspector. Fee $.~e~Jl~ .......... BUILDING DEPARTMENT ~ ~/~ ~ ~ TOWN CLERK'S OFFICE ~ ~ / ~ Examined .~....~5 .............. , 197.~ ,,,~.i~ ~Y~ ' ~pplication ~o ................................ ........................................ ,v ........ emit No ..................................... Disapproved a/c .~......~......~ ......... ~ APPLICATION FOR BUILDING PERMIT Date ........... ~.....'~....~.. ............19.?....~....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wJt~ 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 or areas, and giving a detailed description of layout of property must be drawn on 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 the premises available for inspection throughout 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. 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, Suffo/k County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as J~erein desc(ibed. The applicant 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. OWNER BUILDER CONSTRUCTION COORDINATORS .............(SP:'(~:'R~g~OX' .... $87. :~"~ ..................... ~. 'f a car'"" ........................ oration) (Address of applicant) State whether applicant is owner, leSSee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ..................... ............ ......... : ................................................................................ Name of owner of premises ............ ..-..~....*. .......... .~..././././././././.~ ................ ~..: ................ ~ ......................................................... If app~aa~t, i,s ~_orp~r~ate~ignature~duly authorized officer. ,~ ....... .......................... (Name and titT6~of corporate officer) 1. Location of land on which prop~d work will be done. Map,,NNo.: .................... Lot No .............................................. Street and Number ................... ~.; ................ ~r~...w~,,.....~......~ ...................................................... .'7:.......~.. ................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ . .~..O....~...-J~... ......... . .~....F....~.j.~.~r~ ............................................................................... b. Intended use and occupancy .~,.~. ......................... '._____/~:..~--;!...C~.. .................................................................. ...... ~,~~3 '/" ~, 3." ~Natare of work (check which applicable): New Building ....................... Addition .....~ ......... Alteration... ............ Repair ......................... Removal ......................... Demotition ........................ Other Work .................................... (Description) ..q..q..q. ................................................................................................. 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 ....~...~..&...~....~..~.!..c..~F,... 7. Dimensions of existing structures, if any: Front .;.~..~...~...~...... Rear ...~...~....~.. ......... Depth ......... ."~..~....~ ............... Height ........... .J..~.. ........ .~. ................................ Number of Stories .............~../.....~. ...................................................... Dimensions of same structure with alterations or additions: Front ...~.~...~....~.. ........ Rear ...... .~...~......-~...~;..; ................. Depth ........ ....................... Height...................../3 ..-~.................. Number of Stories ....... ~Z.~,~. ....................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ..................................... ; ........... Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ............................... .: ..................................................... 10. Date of Purchase ..................................... Name of Former Owner ....... ..~....~..8.:...~1~.,.~¢,~ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ........~..~F.~,'~ ................. Will excess fill be removed from premises: [ ] Yes [ ~ 14. Name of Owner of premises ..... .~.~..{~.........~'.~iw~:.~ ...... ..~..~.:...~i~.~.~ ............ ~ ...................................................... OWNER BUILDER / (Address) (Phone No.) Name of Architect .....~'.....~.(~I~I~{;~I~ht.C. QD~DINAT~3E& ........................................................................................... \ P.O. BOX $87 ' (Address) (Phone No.) ~J PORTJEFFERSO N.Y I1// ' Name of Contractor .............................. ~ ....... .. ........ ~. ................................................................................................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW Y.C)RJ//. COUNTY OF ........ ~ .............. ) ......... ........ ~..,-.....,,.,/'.,.'.~..,.C~, ............................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the .............,.~7....~...~..?..~~ .................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul¥~thorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of hi~ kno ~, ,.~ aTa~d~lf; and that the work will be performed in the manner set forth in the application filed therewith, ot~ry PubJ~c, St~te of New Yo~ ~ ~~. No- 52-0344963 Suffolk Couell~ ............. ~,. ..... day of .................. ~m. ,,~xpires Notary Pub~~...~~ounty ........... lOCK ,BOX Y ® POSTMASTER SERVICE LO F:3 P_, Y W O R K ROOM EX ST', ~U L DIN M :AI'L VEST,.. C ONC'. SLAB WOMEN ,5 LOCKER 'ROOM JAN, ' CLST, MENS LOCKER ROOM /,' ', 1i7','77. N q b EX~$T. L EXIol NEW E STORES _/ 0 V E L A N E ~ 'TE h,~ OT E $ NEW PAVED AREA ~TORM WATER RVN BUlL EINGS HAbE E X IS% [~RAIN, RUDOLPH BOX 567 PORT oEFFERSON (~ ' ~r ~ RTOLDUS N.Y. 11777 R E. DEPARTtqENT NEW YORK NEW MATTiTt ~CK'- PLAN 104 C,F "ttF AI'~MY 015I' GOR't~-.' OF ENG, RS, '1' OR H, tx~ ,Y, EX 5ER¥.tC E LO I~I~Y ¸E X :/ B .UI L S LA ~ M 'A t,L ~'OCKE R ~ ,, ~.,"',:, '~ MENS ,LO ROOM ,' ~: ,, ,, ,, ',, WO DING C [ ( ' I:~ I:~ Y W(RK FOCM MA tL VEST, SEC T!C 1~,I A'-A FIRON F ELEVATION L>, ST STGRE -- __ .c T L'CCO ".:: FRAY' WHITE EXIST S _TORE REAR ELEVATION RUDOLPH G. BARTOLDUS R E, BOX .5 87 PC)PT JEFFI:RSOI'4 i'4.Y, 11'7;'7 DEI>A,RTMf NT OF Tr, E NEW 'fORK-DIST, CORPS· 0~. NEW YORK N-Y. ~A'~ITUCK ~,, ROOF .......... x-~ -? ..... I / DETAIL [2] DETAIL [] DETAIL RUDOLPH G, BARTCLDUS P,E. BOX 587 PORT JEFF'E'IASON I~J,Y, 11777 DEPARTMENT OF THE ARMY NEW YORK DIST, CORPS OF ENGR.5 NEW YORK 1'4, y. MA'TrlTUCK F',C, ROOF AND WALE SE P.L A IN 'TI ONS ,%, OFFI C ~ ./ - I OWNI~ BuILI~I~ CONstRUCTiON COOROlNATOn$ P.O. BOX 587 I~ORT JEFFERSON, N. Y. 117~7 ' -- ;r--.. - ' - ~ i ' W LOCKER ROOM 1~'-,~, I ~: 5 ,,., , , ¢~,-- .<<, . . ~ % ., SERVICE LO~Y ' %"1 FI R.~T FLCCR RUDOLPH G, E~A RTO'LDtJS ,,l~OX 5 s7 , DEPA,RTME~T,, f 'I D ET $2 RUDOLPH G. I~ARTOLDU$ ' P,-E. R O, BOX 5157 PORT JEFFERSON N.Y, 11777 '1 DEPARTMENT OF THE ,'. .-NEW YORK DIST. CORt:;~S OF ENGi~.,,~, 'j,' 'l .~EW YORI~ N,¥. ' ,MA~ITUCK R O. , ~ , , , ,:' PLAN