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Home My WebLink About7312-zFO~M NO. 4 TOWel OF SOUTHOLD BUH.I~IN(~ DEPARTMI~Fr Town Clerk's Office Southold, N. Y. Certificate Of Occui~ncy No. Z.6.0.~2 ...... Date ............Augult ....~..., 19~.. THIS CERTIFIES that the building located at Il&tm&tr...pe~,,t .Roe& ...... Street Map No. ~assau. P.t Block No ........... Lot No.. 67. .... L'utekQgue. ~ .1~,¥., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......June...¶0 ...... , 19.~S~. pursmmt to which Building Permit No. dated ......... June...10 .... , 19.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pr~.~ate. one. fmai~..~vell~ng, wAth. an. addt~ia~ ................. The certificate is issued to $~Falx 2,~ B~e~. ....... 0will'. ........................ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant ) · .11 oIL. ............................. UNDERWRITERS CERTIFICATE No. ~1~63993 ..... Jmm..? .... ~92h. ............. HOUSE NUMBER .. 8~2~ ....... Street ... Nas~at~ .l~eLut .Ro&d .................. FOI~i NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PEPJVII'I' MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7312 Z Perm ssiorl is hereby granted to: pursuant to application dated ........................~,ll~e.-...$O--: ........ , 19~....., and approved by the Building Inspector. H , rov .......... .?. ................... , I~OBA[ BO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Pemit No ..................................... Disapproved a/c ................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, withal~ 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 lavout of property must be drawn on diagram which is pert of this application. c. The work covered by this el3~olication 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 shell he kept on.~l, 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 Ce.rtificate of Occupancy shall have beene: 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 con.ruction of · buildings additions or alterations or for removal or demolition, as herein described. The applicant agrees to comply with III II~licable IIW~ ordinances, building code; housing code, and regulations, and tO admit authorized inspectors on IXemi~es and in buildingr for uecaseary inlMctiom._~_. (Signature of applilaht, or hetne, if a corporation) ...... ...~-~. ..... (~*(~ress of applicant) .... ~.. State whether applican.~/~e~r, J~/~nt, amhitact, engineer, general contractor, electrician, plumber or builder. · .................................... ....................................... . ......... .............................................. ...: ....... " Name of owner of premises .... ~...;....~"....~-~.~...~.. ............ ,...~ .......':~.'2:~ ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... ~:.Eiectrician's License No ..................................................... '~Other Trade's License No ................................................... , / 1:~ Location of land on which proposed work will be done. Map No..a(,~.,~.~..../.~.~--~.~-,.Cet N~o.-.~ '~,~-~:.~ Street and Number -~/~/~~`/~`~/~/-~/~(~.~`~/~`~-.~`~"~(C~""~"~"~ .~:..~ // ~vlunictpaitW 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .................................................. .~=v.....; ..................................................................... Intended use and occupancy .......... ...~....~.... · -~..~-..~. .......................... : .............................. ~ 3. I~tul~of work (check which applicable): New Building ....................... Addition ............. Alteratlon....~. ......... Repair ......................... Removal ......................... Demolition ........................ Other Work ............................. ;, .... (Description) 4. Estimated Cost ltD be paid on filing this application) S. If d~?~li?g, 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 ..................................... 7. Dimensions of existing structures, if any: Front .......... Rear .~....~......: ............. Depth .~:.. ........................... Height ,,~..~,:. ...... ,/,,~,~ ...... · .................... ::... Number of Stories .,,,~,,~,,~.,,,,,, ............. i ....................................... Dimensions of spree structure with alteratmns or addi. tions: Front ,,,,,~,,, ............... Rear .,~ ................................ Depth..../..;~.. ................................ Height ....... .............................. Number of Stories ...,..~ .................. · ' . . ~ //~ · 8;' Dimensl~tof entire new construction: Front ...~.,7,, ................ Rear ...~..~.. ................... Depth .. .. ~....~:.. ...................... Height ..! ......................... .:,. .................. Number of Stories ..../..~.~. ........................... ~.v ......................................... 9. Size of Ioti Front ......... /.~..,..O. ................... Rear ....~......¢~. ............ ./ ............. Depth ...~Z';/..{~I:7~. ................................... 10. Date of Pumhase ..................................... Name of For~ ................................................................... 11. Zone or use d,strict' in which premises are situated ..... ~~ . 12.' ' · · . 4.xO. Del~s i~r~oposed conStruction violate any zomng law, ordinance or regulation ............................................................. 13. Will~ lot be regreded --:~.~...~...:j ............. ,,. Will.ex_ges~ fill be removed,from premisiis; [~ Y_,es~ ~] No 14. Name of Owner of premises ...~..~.g...~.6!1~..~......~.,..~ ....'.~....~.....~....../~...Z.~ ....................... (Address) (Phona No.)~ Name of Architect ....................................................................................................................... i~ ....... '~ .................. ,,.,., .,,_ o., PLOT DIAG RAM Locate clearly and diStinctly all buildings, wh.ether existing or proposed, and indicete all set-back ~i~e~ion~ from property lines. Give street and block number or description according to deed, and show street names an~b~dicete wbeth. er Interior or corner lot. · '- STATE OF NEW YORK. COUNTY OF ...................................................... ) SS ...... · '. .............................. be~og duly sworn,~d~o~s and sa¥~ that he is the applicant abo~ namad. ~ - ,' ' .t~var~ ~ing~l~dual si~tng contract) ' . He is the .............................. ...................................... .................................................................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized 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 his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith, ...................................... day of .................................................. 19 ....... Notary P~blic ...................................................................... County .......................................... THE NEW YORK BOARD OF FIRE UNDERWRITERS I-- ak BUREAU OF ELECTRIcrr'~ . - 85 JOHN STREET. NEW YORK, NEW YORK 10038 ~,. June 7. ~97~ ~pp,,.,o. No.o.,,,. 73~370 ' , ~ 83593 THIS CE~IFIES THAT ~ly t~ ~t~ ~uip~nt ~ ~N~ ~ a~ i~t~ by t~ ~t M~ on t~ a~ ~pl~a~n ~um~ ~ t~ p~m~s of A~ld ~. Beheer, e/n~de ~a~sau Point Rd.. 700' n/o Bridge ~ne~ Cu~oho~u~ in t~ fol~ing l~atlon; ~ B~ement ~ lst FI. ~ 2nd FL ou~61de ~tlon B~ ~exami~don June 3~ 197~ andfou~to~in~mplia~e~lththe~ui~mentsofthlsB~rd. RA~ES SERVICE DISCONNECTt ~ HO. Of ~v 5 R METER 1 200 C 1 ~/0 OTHER APPARATUS: Elec.~oom hea~er~: ~-2.0kw, 3-1.Skw, ~-l.25kw, EXHAUST FANS DIMMERS John M. Lademann, 1200 Harbor LaneR Cutchogue, L.I. 11935 V I ¢ 2/o 2-1.Okw, 1-.75kw, 2-.Skw COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MAHNER.~