The URL can be used to link to this page

Home My WebLink About6973-zFORM NO, 4 TOWN OF $OU'I~OLD BUll.DING DEPAHTMF, NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .N./.~...l~..i.n..R..o~t..4. .......... Street Map No. ~ ........ Block No..:~X;l; ..... Lot No...:r-lClC... }lit~i;l.t.~¢ll:.. ~.. ...... conforms substantially to the Application for Building Permit heretofore fried in this office dated ..........N. 0.v .... ? .... , 19. ?.be. pursuant to which Building Permit No. 69~3Z.. dated ..........N. 9.v.... 7 ..... , 19..7.bf., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .iR.o.b.e..r .t..L.:..B.e.r.g.e.n. ...... .0~..q .r ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N...~.; .............................. UNDERWRITERS CERTIFICATE No...N..1.~.~..6.~.~. ....... .lp.r.l.1....8....~ .9.7.~. ......... HOUSE NUMBER..~?.0~. ....... Street ...... .)l.~...R. qe .d ......................... POB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6973 Z Date ......................... ~ ............~. ........ , 19..7.3. Permission is hereby granted to: ~.u .....~ ........ ~'-~ ~...Inc.. ~ll..P, oher-t ..L · Bez'ge~ ................ ~ ,.,~t ~,., ~1~ ......................................... to ..... ~ .~.~.~ ~....%,! L...a.~,.~i..~,.1;.~.:~...9~ L. :~ a~, ~ .i:. i~:~..ba~ :,,,n ~a a...h 1,tt L~.:i,ng ...................................... ~t pr~mlses Iocoted at .~...;.~J.~..~.t@~.O....~.;~...~~l.~.~.~...&Y~ .................................................... ~att~ tuck pursuant to application dated ..........................~:,'..~g. ......... ~. ........... 19~..., and approved by the Building Inr~tor. Fee $~..;1.~..;/ ............ · r'" Buildih~ Inspecto~ Approved ............................. .-2.. ....... , '~ ~ ~'7.~ ~ 19 ........ Permit No ..................................... Disapproved a/c .................................................. - TOWN CLERK'S OFFICE souTHOLD, N. Y. Application No ................................. APPLICATION FOR BUILDING PERMIT Date ~0'9' ? 19...~.3. ~r~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildi Inspector, with 3 sete of plans, oocurate 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 areas, and giving o detailed description of layout ofpraperty must be drown on the diogrem 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 perm t' shall be kept on 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, Suffolk County, Now York, and other applicable Laws, O. rdinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as here,n described. 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. Edw. Abitz contract~ ..................................................... ................................ (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Robert L. Ber en Name of owner of premises ................................... .~ If applicant is a corporate, signature of duly authorized officer. Electrician's License No ............................................. Other Trade's License No ............................................... location of land on which pr~f~g~sed work will be done. Map No.: ........... ~ ........................ Lot No .....~ .............. Street and Number ..~.../..~.......a...~.~....R...o.~.~. ........... ..~.~..~..~,~-.~1~¢~ .................................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ..~..o..~...e.~....$.~.o.~. .................................................................................................. same with an addition b. Intended use and occupancy ............................................................................................................................... .~ ) 3. Nature of work (check which applicable): New Building .................. Addition ..... ..3~c.....: ..... Alteration ................. Repair .................. Removal .................. Demoliticm..:....; ............ Other Work ................................................ . ..... (Description) 4. Estimated Cost .................. I~.Q.Q.,.t ................. ~."...Fee ~.'*..0.-0.- ........................................................................... ,~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .0. .............. ;..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 ............................ Number of Stories ................................ 1 8 . ........ 2,~{ .............. Depth ....2.~, ............... 8. Dimensions of entire new construction: Front .......... ! .............. Rear Height .................... Number of Stories . o]3.e ....................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...Bw.1 ........ B3As~es8 ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~3~ ............................................ 13~ Will lot be regraded ....~Q ................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....~L,L-Ra3~gmzz ....................... Address ....~a.~,~,i:l:;=cl~ ..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .....]~.ql,~..~,]~.t;~.....~PD,.$~'.~,.(~.l;Q~'...;~Z;~ldress ....... ~;.t,l~,3A(:~ ..... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. I STATE OF NEW_YO_R~,_ ~'SS COUNTY OF ....~.I,LT,~,.Q,U& ........... i ' Edw Ab gt . ................................................................................................. being duly sworn, d~es and soys t~t he is the ~plicom (Name of i~ivi~al signing controc~ above name. Builder He is the ............................................................................................................................................................... (Contractor, agar, co,orate officer, etc.) of said owner or ~ners, and is duly authorized to peHorm or have performed the said work and to ~ke ~nd file this application; that ell statements contuin~ in this application are tree to the best of his knowledge and belief; end tha~ t~ Work will ~ Performed in the manner ~t forth in the application fil~ therewith. Sworn to befo~ me this ~ · ~~ ~.~........~f No. 19 7~~ .... .............................. ~ ' - (S~gna~re ~ a~plicant~ ~ T. BO~N ~ ~lic, Sta~ of N~ Yo~ ~. 52-~44963 Suffolk Cou~/ ~ ~pims Ma~ 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY [~ 85 JOHN STREET. NEW YORK, NEW ~ORK 8. ..,,.,,o. No.o.,,,. 7 59 o N 152653 THIS CE~IFIE~ THAT only the e~t~ ~ipme~t ~ ~c~ ~ ~ ~nt~ b~ t~ ~p~ ~ o~ t~ a~ ~pl~t~n ~m~r i~ t~ p~m~ o~ R.L. Be~en, ~lde ~ln Road, 200~ ~o Pao~o~y AVe., ~ttltuok, ~.~. in thefollowlnglocatlon; [] Basement [] ~. pl. [] ~na r~. out;side S~.on waz~,~minedo. Apr'/]. h~ 197tl and found to be in cornpl~ance with the requ~rements of ~hia ~oard. FIXTURE LBCBPTAC'=SI SWIT HE I FIXTURES 7 ~11 ~ 7 DRYERS FURNAC! MOTORS FUTURE AI'FtJANCE FREOBRE AMT, ' K,W, OIL H.P, GAS H.P. A~T. NO. A. W, G. RANGES SERVICE DISCONNECT NO. OF I S AMT, AMP, ~fPE ~.~J~ l~'2W 1~ 3~ 3~4W NO.~ CC. COND. OTHER ~ARATUS: R V I C EXHAUST FANS DIMMERS A. W.O. ~O. OF HI-LEG A. W, G. NO, O¢ NEU1RAL$ OF CC, COND. ~ HI-LEG OF NEUTRAL F.W. Brudi, 1192 Waverly Ave., Holtsville, L.I. 11722 mW¸ Per , ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.