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Home My WebLink About5793-zNO. & TOWN OF $OUTHOLD BUrg,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~ .Road-~' '(' .l~t~riek -1~eet Map No.~ .......... Block No.m~ ........ Lot No..~,~... Oriel~' .l~.,']~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .Ipr. 1~ '~9~ &' July. ,219.75. pursuant to which Building Permit No.~?~. & dated Apr- .~ -19-~ .&. Ju~y- 3-, 19F~.., 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 . Dorm3,d. (hl,~.k~on ....... ~.,~e~x, ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ,~.,R, ............................... UNDERWRITERS CERTIFICATE No. ~31~8~ ..... A~g. 2..1~7~ .................... HOUSE NUMBER .. ~h4) .~ ....... Street ...P~.i-vate..P~&d. ~.?...(1)led~iei~ -Rd')" Orient I~.Y. [ ' Building Inspector / 801+63 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- ad . Jo.. ST.EET,.EW YOR.,.EW YOR.'OO'8 34823 Date Application No. on file N THIS CERTIFI~E~ , · ' by t~ applicant ~med on the a~e applica~io~ number i~ the p~nises of Donald Gullakson No~th End of Private Rd. 3000'n/off Main Rd. ~,,,,~yo,o~i.~.,~o-; ~ ~.,~,t ~ ~,,r~. ~ 2,,d ~. outside s~o~ Orient, LI~. ,,.,,,..o,,,i,,¢do. July 31, 1972 OTHER APPARATUS: W. L Ruland ,:R*L ~, / ER Mattituck, L.I. G~L~ ~. ~ P~r D This certificate must not be a~tered in apy manneq return to the office of the Board if incorrect. Inspectors may be identlfie~l by their credentials. FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 5793 Z Permission is hereby granted to: ............. C~l~m....ll~.~, .............................. to ...... ~..~..~.t..~..~...m~...~z..~.ezt~ ......................................................... at premises located at ......Jl~l~..J~t...JJ~..~j~.J, ll...JJ~ ............ ~'"D~L~JI:"JJ~O;,~J'~') ....... pursuant to application dated .........................~IL~,~....~ .......... , 19..~J,., and approved by the Building Inspector. Buildin~~ Inspectlr TOWN OFSOUTHOLD ~ ~ /~,~ ~ ~ ~C~ ~,bc/~'Z. ~, -/~ ~,/f?~-~ BUILDING DEPARTMENT.~,.~ TOWN CLERK'S oFFICE ~THOLD, N. Y. ,gZ . Exomined ~proved 19 ........ . ....................................... , Pemit No ..................................... Disapproved a/c .... ~'""~ ~o ' ' ..................... ................................. Date ........ ~...,..~. ................ , INSTRUCTIONS This application must be completely filled in by typewriter or in ink and 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 ofpraperty 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. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sha~l 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 demo tion, as her.e, in described The applicant agrees to comply with all app~cable laws, ordinances, building code, housing code, and regulahons. ' (Signatur~ of applicant, or name, if a corporation) ............................. ' X'iiil ';;,';; '; F gl; ; V 9 ................... State whether applicant is owner, lessee, a~ent~engineer, general contractor, electrician, plumber or builder. Name of owner of premiSes ............ ~...~.....~ ........................................... i ................................. If applicant.is a corporate, _signature of duly authorized officer. (NamJd and title of corporate officer) 1. Location of Number .~.~.. ~Q/ ! ~. .' .............. and on wh ch proposed work w be done Map No ..................... Lot No ......... Street and ............................... ; ......................................................... Municipality ...................... State existing use and occupancy of premises and int;r~ded, z~ a_nd occupancy of proposed construction: a Exstn use and occu anc b. Intended use and occupancy ............................ ~.. ..... ;...~.:~ ......................................................... 3. Nature of work (check which applicable): New Building Addition ~'~'J ' .................................... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost /...~..)C)'C:~.~ ........ 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. tf business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............~..~. ........... Rear ......... .3'.~ .................. Depth .......~...~. ........ / Height ....... .,~.O. ............ Number of Stories ............................... ././.~; .............................................................................. Dimensions of some structure with alterations or additions: Front ........... ~.~......~. ............... Rear ...... .~'...~.....~. ............ ¥ ~-O ' I~u--~e- ~f Stories .......... ../...~..zc.. ............. Depth ............. ~.~. ............ Height .............................. ,.u · v 8. Dimensions of entire new construction: Front 2.0 Y O ~' .................................... Rear ........ ..~ ................. Depth ...... ~'..~.. ............ Height ....... ~..O.. ........ Number of Stories ........ /..~.~. ...................................................................................................... 9. Size of lot: Front ......... /..O..~..:...~../..... Rear ......... /..~..~.. .................. Depth ........... ./...~...~..: ........... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................... ..~... ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .....~ ................................................. 13. Name of Owner of premises ..~Z.~.~...~.?///~.~.T~...~.. ...... Address ......................... ..(~..~1.¢."...~. ..... Phone No. ~.Z..~....~..~..4.. Name of Architect ........................ ~ ............................. Address ............................................ Phone No ..................... Name of Contractor ~...¢R ............ .(.~. ......................... Address ..~.~..~.......C:..E~'.....~.6... . Phone No....~....~...~...5..-.o?.(. PLOT DIAGRAM Locate c ear y and distinctly all buildings, whether existing or pr?posed, .ar~. indi.cat, e all ~t-.back dim,ns!ons.fro~ prc~oerty lines. Give street and block number or description aocoraing to aeea, aha snow street names aha inaicare whether interior or comer lot. <~¢ c~ )~/~c~ ~ e/ STATE OF NEW ~vo~. ~/~/. !, ~ c ' COUN OF ................... ~.....~,~.. ..................................... being duly sworn, d~ose~ and says that he is the applicant (Nam~dividual signing application) tovenamedHeisthe .... ~ ................................................. ~ ................... ........................................................... (Contractor,'~gent, corporate officer, e c.) ~aid owner or ~ners, and Js duly authorized to perform or h~e performed the said work and to ~ke ~d file t~i~ ~pplication; that all statements contoined in this application ore tree to the best of his knowledge and belief; and t~he work will be performed in the manner set fo~h in the applicati~ filed therewith. Sw~ to b~fo~ me this 19~ ......... ........ ........ , N~a~ ~ubli~~~~oun~ ........... ~i~ ~ ' ~ '~ ~'~ ............................. No 52-~344~63 Suffolk Coun~