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Home My WebLink About6952-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ofiice Southold, N. Y. Cerfi{icate O[ Occupancy No.Z.~8.7~ ....... Date ....... Apr.i~...30 .... , 197.~.. THIS CERTIFIES that the building located at .~./.~ .t~ain. Roa..d ..... Street Map No.{x ..... Block No..x. ...... Lot No .... ~ . 0r.ie~..N,.Y.,. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. t~¢%obel'..2~, 19 73 pursuant to which Building Permit No. dated .... 0e, t; 2{.. , 197.3.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ssued isPr.~va~.? .o.n?, ~?.i.~.?..a.¥?.~..~.i.n..g ................................. The certificate is issued to l~rs .Raymond. 57.a.b.o..z, . 0~ne.l. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 10I'.e-, exf~!ini, s:F.~te~ .......... HOUSE NUMBER ...~.69~.. Street . . .l~..i.n..R.o..a.d ........................... Building InspectorI TOWN- OF $OUTHOLD 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) Permission is hereby grg~t~4.tn' ~" ~ . .....~.~.....~~...~~. ..... ~.~..~...~.~...~: .................... , ,~o ............... ~~~~~~ ...... ~~~~ .......................... ~ ~,,~, ,~ ~ ....... ~..~_~.~~....~~..,. ............................ ........................................................... .~.~~.~.~..~..: ......................................... pursuant to appllcatJon dated ......... , 19 ........ , and approve th Building Inspector. Fee ~...~...~? ui ~ng Inspector THE NEw YORK BOARD oF FIRE UNDERWRITERS ~.k BUREAU OF ELECTRICITY ,' - ~ 85 JOHN STREET, NEW YORK, NEW YORK*lO038 N 150489 THIS ~E~IFI~ T~AT ~ly the e~t~ ~u~ment m ~scd~ ~ ~ Mt~ ~ t~ ~nt ~ on t~ a~ ~pl~a~ numar ~ t~ pMmi~s of in the following location; [] Basement [] 1st FI. ~.~.~i~do. ~arch 25, 197 ti RXTUEE L~CEPTAC SLE I EWITCHIS I RXTURES I DRYERS FURNACEiMOTORS ~TURE AF/tlAN(~ FEEDERs )u~T. ' K.W. OIL H* P, G~ H.P. MIT. NO, A w G SERVICE IXSCONNKT NO; Of S 200 ~B x OTHER JhI~A~TUS: EleCt~ie heaters: ~otor/s: 1-1/2bp [] $nd FI. outside Section Block anH found to be in compliance with the requirements of thi~ Board. COOKING DECKS OVENS DISH WASHERS TiMECLOCKS BELL I UNIT HEATERS MULTI-O~TLET I 3/0 2-3.0kw, 1,2.0kw, 3-1.Skw, 3-1.Okw, 5'.751or Lot DIMMERS 3/e East Marion, L.I. 11939 ~~/ ~ COPY FOR BUILDING D~ARTME~. THIS COPY OF CERTIFI~E M~ ~T BE A~TER~ M ~ ~NE~ BUiLDiNG DEPARTMENT ~ ~ ~ TOWN CLERK'S OFFICE D~sopproved ~/c ................................... ...:, ................................................ ~ "~' ~( Build ~n~q nspector) INSTRUCTIONS a Th~s application must be completely filled m by typewriter or' in ~nk and submitted in triplicate to the Buildin Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee accord?g to schedule. ,q b. Plot plan showing Iocabon of lot and of buddings on premmes, relahonship to adlo~nmg pri~mJses or pubhc streets, areas, and giving a detailed descripbon of layout of property must be drawn on the d~agram wF~ch is part of this applicotior c. The work covered by th~s apphcation may not be commenced before issuanc~of Building Permit. d. Upon approval of this application, the Building Inspector w~ll msue a ~udd~g"Perr~t to the apphcont Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or m pa rt for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuonce of a Building Permit pursugnt to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcoble Laws, Ordinances, Regulations, for the construction of buddings, additions or olterat,ons, or for removal or demolition, os herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and , admit authorized ~nspectors on premises and Jn buildings for necessary inspections. (S,gnature of appl,cant, ~ ,.no/C/if a corporation) (Address of applicant) S, tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises /4¢7~ -~ ~"A ',' Pr' '~ ~" ~ '-7'-/I ~_.~,~/..~. If opphcont is a corporate, signature of duly authorized officer .... '; (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................ Electrician's License No ......................................... %. ~ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No ' . ................ ~ .......... Lot No ..................... / a/* 6 0/;- / z: ,',' F Street and Number ..... , ..... /..~,.~.. .................................................................................................................... Municipality State ex~sting use and occupancy of premises and intended use and occupancy of proposed'construction: a. Exisiting use and occupancy ..................../.~...!?..~.../-..~.. ',"/. ~.."T.:...~........(:./...'.'...~'. ........ /~.:i:~../;.~...~?...~..'~. .................... b. Intended use and occupancy /~t~'t~l 3. Nature of work (check which applicable): New Budding .... ~ ..... Addition .................. Alteration ............. Repair Removal Demolihon .. ~/',¢- ethel' V~.wk ....................................... 7/*~.~/~ ' 6 -~ ....................... i i~'~'~'~il~ t io'~')' ...... 4 Estimated Cost ........................... .~....O. ~.....E, ~...~.....0. ........ Fee ........................................................................... (to be paid on filing th~s application) 5 If dwelling, number of dwelling 4.m~- .......... ~ ................ Number of dwelhng units on each floor ........ {. .... If garage, number of cars .................................................................................................................. 6. If business, commercial or re,xed occupancy, ~f~n~,,me and extent of each type of use ............... 7 Dimensions of existing structures, if any: Front ........................... Rear ................................Depth ............... Height ........................ Number of Stories ................................................................................................ D~mensions of same structure with alterahons or add[tioFI¢: Front ........ :~ ........................ Rear ......... Deplh, ..~: ............................ He,ght .......................... ,~ ,NU~nl~er:., ohSt~o r te:s ~.....~, ...................... 8. Dimensions of entire new construchon: Front ......... ~,¢.~'. ................. Rear "...:.~ ...................Depth .. Height ..... /...~. .......Number of Stories ............ ~::)~6~f£.~ .......................................... 9. S~ze of lot Front ,~.~'.t°, ~.. ~ .................. Rear ;2/~-- ~ .... I¢,,rt, ........................................ ......... ~0. *Dote of Purchase ................................................ Nome of Former Owner ................ ~¢ ................... 11. Zone or use district In which premises are s~tuated ............. ~.Z~.~.~'. ..... t...&..TT:..Lt.'t.z.. .............................. 12 Does proposed construchon violate any zoning law, ordinance or regulation ................. /k/.f~ .............................. 13 Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ~ /~ '- '~? "¢~ £~: ~' ~'~l~one No ...................... 14 Namu of Owner of prem,ses..J~f...[.~. ...... ~...~....~).,G,..~)...~. ......Address~,/' Name of Architect Z /- A .,-z A ~ ^~ . Address ..... J:..:4:?~.E.~./)..~ Phone No ...................... Name of Contractor .... .~.... .~.//~ .2' --,, /~ ~' A,/'I,';, l'~ ~' ..................................... ,~aaress ..~7¢.L:./C..?~...~.X7 Phone N~o.7.~......./..~...~...~. PLOT DIAGRAM , Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and ~nd~cate all set-back d~mens~ons fron property lines. G~ve street and block number or descriphon according to deed, and show street names and ind~cah whether interior or corner lot. STATE OF NEW YORK, t¢c COUNTY OF ............... .~L' .¢::.~.?.L*CJ' ............... ~/..¢.~. .............. ~).L.~.,;Z,, .. ..................................... being duly sworn, deposes and says that he is the opphco., (Name of indwidual sigmng contract) above named. He ,s the .................. ~.~.Z..&~.~..~..~ ................................................................................................ (Contractor, agent, corporete officer, etc.) of said owner or owners, and ~s duly authorized to perform or hove performed the so~d work and to make and fH th~s opphcat~on; that all statements contained m thru application ore true to the best of hm knowledge and belief; th~t the work will be performed m the manner set fo~h m the opphcotion filed therewith Sworn to before me this ................ .,.¢ ...... , , ¢ x / / (Signoture~ appl~nt~ APPROVED · ~: NOTIFY BUILDING DEPARTMENT AT ', 1 'BEFORE BACKFILLING FOUNDA- F ,7¸ 1, BEFORE BACI~FILLING [:OUNDA' TION OR START ~RAMING 2. ~EFORE cOVeRiNG PIPELIN~ 3. FINAL WFI~N JOB C6MPLETED