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Home My WebLink About9011-zFORM NO. i TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O/~ice Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .Sy~I.~. I).~ ............... Street Map No. Ga~.d. ~ .l~lock No ........... Lot No, .~. ~, .F,a~.ion ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ D~...~t~., 19.7~ pursuant to which Building Pemit No. 90.~.17~.. dated ............. D. eC..~.6..., 197.~.., 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 .. P. rivate, o~e. family, dwelling .wl.~h .adf~itior~ .................... The certificate is issued to . Frederick. Lueht; ...................................... (owner, lessee or tenant) of the aforesaid building· Suffolk County Department of Health Approval .. N,~I~ ............................. UNDERWRITERS CERTIFICATE No..N~.~.~0[..~.~*. · .t.~., .1.977. ................. HOUSE NUMBER · · · ~ ~0 ....... Street .... SyX'e. an. D~iva .... E,. ~al'~-~r~ ......... Building Inspecto~ FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER/~AIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTf~ORIZED) N? §01] Z Permission is hereby granted to: dOSE ?/~ N "DI,~ ~ ..... ........ .~. ....... ~.~.~.~.~!.C!~ ....... ~..:....,(:-..~C ~Z to at premises Iocg~ted at ~;"~ L. ~/ /4 Iv' "~-~ ~ V L~ pursuant to application dated ~C [ G 19~ and approved by the Building Inspector, $ 15 Building Inspector "' ' ' THE " NEW YORK ''~'OF FiRE ,: J"~:-:-~' r '.: .: :-~: ~ -BOARD'~ . ::.' U N D E RW~IT~ ~q ~--. :., ::.,; -~ ~ ~' BUREAU ~ ELECTRtCI~ '' , ~ ~ ,:d; '; 85-JOHN STREET, NEW YORK, NEW YOrK:IOO3B :~-,~,~,~-~.~r~:,-:,~?. ,~::. :~., -', ,~ ,--.~:: ..' :-::: -.~:,,~;.~,.:,. , ,:'- ,N 328850, -, ~; - ~ hucns,- uardlners Bay ~states, Sylv~"~ane. Tins certmcote must not be altered n <:nv monner return ......... 0i L__O~O'ST TOWN OF SOUT.O' O BUILDING DEPARTMENT TO~H CLERK'S OFFICE ~UTHOLD, N. Y. / ~p' roved . ....................... ................................................................. .................... - APPLICATION FOR BUILDING PERMIT Oote ......... ......................... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 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 areas, and giving a detailed description of layout afproperty 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 Buildi~lg Inspector will issue a Building Permit to the applicant. Such permit 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, New York, and other annlicoble Laws Ordinances or Regulations, for the construction of buildings, additions or alteratio'ns, or for removal or de[n~)lition, as h~rein 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, .............. ..................... , ........... ................................. (Sighature of app ice't, or na~ 'a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................. ~ .................................................................. applicant 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. f~ ' 1. Location of land on which proposed work will be done. Map N~).: / Lot No. Street and Number .......................................... ; ........................................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: e. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal ..................Demolitior ..................... .Qther Work ................................................... t ~°O / . ~,- (Description) 4. E:stimated 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 ........ ~ .................. 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 ........ Z ....................... Height ............................ Number of Stories .........' ....................... 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories .................................................. .~. ................................... 7': .......................... 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 ....................................................... r'l ........................................... 12. Does proposed construction violate any zoning law, ordinance or regalation: ........................................................ 13. Will lot be regraded . .......... ................. Will excess fill be removed from premises: ( ) Yes (') No 14. Name of Owner of premises ........................................ /...,,,...'i.. Address ~ Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ....................................... . ................. Address ................................ Phone No. PLOT DIAGRAM Locate cleariy 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 whether interior or corner IoL STATE OF NEW VORK,., COUNTY OF ................................ ........... ,~ .............................................. g duly sworn, '-~ ~, ~. ~ ¢ ' ~ ' . ........ be n deposes and says that he is the applicom (Name of individual signing contract) above named. 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 end file this application; that ell statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , day of ......... .~ .............. /...~ ............... IcJ ........ :' , ,' ,' ........................NoraW Public, ' !UDITtt T. [~O~{EN //%',, I,, '" . z /,/(S~gnoture of apphcont)