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Home My WebLink About8689-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ]t.o.I~i~c~tl....LalR~. .... ........ Street Map No...Xx ....... Block No. XXX ...... Lot No... F,~X...8.o.~l~.h.o.l..a...N.: .~.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ gltll~.. ~. .... , 19 .~.~. pursuant to which Building Permit No...8.6..8.c).g. dated ............ J..u!.~... ~.8.., 19.76., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Private..o~e..l~t~l~y.. ¢!e.e.l.~,in. g. ~li;h..a./~d..i.~.i.o..n ..................... The certificate is issued to .E.~. g.e.n.~..L....F .$~.c.h.e.?. ~.~ ..... .l~. ~t~. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .I~.,.It.,. .............................. UNDERWRITERS CERTIFICATE No...~l.,.R.,. ..................................... HOUSE NUMBER ...7870 ...... Street ... ttorto~a .Larie. ..... ~.O~.h.c.,].,.d ........... Building Inspector FOEM NO. ~ TOWN OF ~OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8689 Z Date ......... ~.IU2e...2.~ .............................. , 19....'[~ Permission is hereby granted to: ~gene Lo Fische3~ Sro 9890 Harmon Lane ................ .~,...~.~...~., ............................ c~r~.struct addition ~p ~ saz'aene~ ~ ~o .......................... g ...... p ..................... ~ ~ ~o~,~ ~ ........ ~29..~S.~s~..~,~s., ................................................................................ ................................ ~.~,al~ +..~;.,...~, ............................................................... pursuant ~o application d~tea ............. [~...~.~ ....................... , 1~...., and ~roved by tae Building Inspector. ............. Building Inspector ............... ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .............. .................... 19.Z .. Examined June 8 Approved ~T~...2.~e ..................... , 19.~,~.. Permit No.....~.~.~.c~ ....... i ............ APPLICATION FOR BUILDING PERMIT Date ....... ~....,'?...S ....... ~..~......?..; INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t° schedule. ': ' b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o; areas, and giving a detailed dr~cription 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 o 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. B .A,P, PLI~ATI? .IS HEREB. Y.MA~DE to .the Building Dep~rtment for the issuance of a Building Perm t pursuant to the ui~aing Lone ~Jrainonce at the /own at 5outhold, Suffolk County, New York, and other applicable Lows, Ord nonces or _R,eguloti,o. ns, for the construction of buildings, additions or alterations, or for removal or ciemolit on, os here n descr bed. ~ne apphcant agrees to comply with oil applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... .............................................. ........ (Address or applicant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ?. .................. ~ ................ , ................................... . ........ ; .............................................. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No .............. ~..e.~;~, ........................ ;.; Plumber's License No ....... ~X..' ................................ £1ectrlcion's License No .... ~,~ ............................... Other Trade's License No ........~ ............................ Locat on of and on wh ch Drooosed work will be done /V~aD No ' . / c~ c> .~'~,/ /nt I~n Street and Number ./~....~..~....~. .~..o.?=/..~...~....~....~.: 2..o..~.....~..£ /..d.: .~.;./.: ...................... .: ......................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed coe~struction: a. Exisiting use and occupancy ...Oxze..~.a~;Ll?...Ee.sirlez~(=e ............... ~ ........................ b. Intended use and occupancy ..... ~.~][~,~....~.;~.I~..~L:&~i.~Q~...~I..~C~J;L ....... :.;~,i; .................................. 10. 11. 12. 13. 14. property lines. Give street and block number or_d~script~ejn according to deed, and show whether interior or corner lot. ~.~ /[0¢~J ,, ,, Nature of work (check which applicable): New Building'. ................. Addition .................. Altelration ....~... ....... Repair .................. Removal .................. Demolitior ..................... Other Work ....: .............................................. (D ;scription) (to be paid on filing this application) If dwelling, number of dwelling units ............................ Number of dwelling units on each tiao ............................ If garage, number of cars .... ......................................................................................................... "t ............................ If business, commercial or mixed occupancy, specify n, oture and extent of,each type of us~ ................ 7" ........ Dimensions of existing structures, if any: Front .......... ~./... ............ Rear .....zT~'. ...................... Del~th ...~../.. .......... Height ........................ Number of Stories ........... / ...................................................................... l ............................. Dimensions of same structure with alterations or additions: Front ................................... Rem ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ............ ~ ....................... Rear ............................ DE pth ........................ Height .................... Number of Stories .................................................................................................................... Zone or use district in which premises are situated ...... I.~.e..5/..c/.c..~..../'z-~../....u ................. Dees proposed construction violate any zoning law, ordinar~ce or regulation: ......x~..o ................ Will lot be regraded . ................. /.~'..e..... Well excess fill be removed from premises: ( ) Yes Name of Architect ' Address ................................ Phone Name of Contractor ....................................... : ................ ~... Address ................................ Phon, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b: :k dimensions fi'gm street ~ames and indicate (4) No. NO. STATE OF ND/V YORK,~. COUNTY OF ...~.~,,f..:~.o.'..~..~. ............ f-'.-' ' ................. ;L.....~u:~e.,..~¢.8q~e-:~ ........... ~ ...... :;,. ................ being duly sworn, deposes and says that ~mame ~T maiviaual signing controcr~ above named. he is the opplicam He is the - t~ntractor, agent, corporate officer, etc.) . of said owner or owners, 'and is duly authorized to perform or have performed the said work an( to make and file this application; that all statements contained in this applica~on are true to the best of his knowlEdge and belief; and thor the work will be performed in the manner set Torth in the application filed therewith. Sworn to before me this ' '" 28.'J;~L day of J..g,g..e, 19 76 ............................. ..... Note~ Public, . ............ ~ · . '.'~ = ............................ ELIZAB~H ANN N~LLE ~TARY PUBLIC, ~e of New York~