HomeMy WebLinkAbout3873-zF(~I~M NO. ~
TOWN OF $OUTHOLD
BUILDING DEFARTMENTi
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. Z 3086 Date i M.a.y. 21, , 19 68
THIS C£RTIFIG5 that the building located at .... .O...~..k.....~..~.~.~...e.~. ......................................... Street
Map No ..... .8...5..6. ........... Block No ....................... Lot No..~.0..&..3..~.:......C._~.~.~..~..Sg..~.e..~....~..e..~.....Y..°...~_k. ....
Eugene Heights
conforms substantially to the Application for Building F~ermit 5eretofore filed in this office dated
..................................... ~.~r.....?.~ ............. , 19..6...8... pursuant to which Building Permit No...3...8..7..3....Z..
dated .......................... ..~.9~.....?..~. ........... , 19...6..8..., was issued, amd conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is ........
..........................................................
The certificate is issued to ....~.?~.~..~....A.?....~.~..~...g.e..~.!.....qr~..~.e.~ ..........................................................
(own6r, lessee or tenant)
of the aforesaid building.
Building Inspector
FOR~I NO. 2
TOWN OF SOUTHQLD i
BUILDING DEPARTMENT
TOWN CLERK'S OFFIGE
SOUTHOLD, N. Yo
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTil- FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3873 Z
Permission is hereby granted' to:
................ ~.~...~.:...~,.~... _ ..._e.~. ......... i .................
.................. .c..~?.~ ..~... ...................... !.~ ...............
Building Inspector.
NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Yo
Appraved ........................................ , 19.?. .... Permit N~. · ·
Disapproved a/c ........................... ;; .......................................... .
INSTRUCTIONS
Application No. '~ ~' 73.
a. This application must be completely filled in by typewriter or in i~k and submitted in duplicate to the Building
Inspector.
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 d~scription of layout of property must be drawn op the diagram which is port of this application.
c. The work covered by this application may not be commenced beforelissuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the progress of 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 Yc~rk, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or f~r removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, b,~ildi~gg code, housing code, and, regulations.
..... ......
(Signatur~ of/9/pplicant, or name, i~a co,oration)
· · ...... ......
State whether appl~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........................
Name of owner of premises '.'.'.i~.~/.....6/~.'~.-." ................................. i~'""~'~~ ~ ............................................................. . ...........................................
If applicant is a corporate, signature of dul~thorized officer.
7~ 7 ~ ~ '
1, Location of land on which ~posed wor~ ~,1. be done. Map No.: ...... ~ ................. Lot No~ .............. /. ....
Street and Number ..... .~.~'.....~ ............................................... ~~~...~~ .....
2. State existing use and occupancy of premises and intended use and:occupancy of proposed construction:
a Existing use and occupancy ~ ~J ~ ~
..... ~ ........ : ........~. ..................... ]: .............. ........................... ~ ........................
b. Intended use and occupancy ........
3. Nature of work (check which applicable): New Building .... ..............~ Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other '~ork (Describe) ........................................
4. Estimated Cost ........... .l.Z/.~...,~=.. .............................. 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.~,a.s,~cc,)~yZr n~,~_,,and_ ,, extent~f~e~,c~ type of use "'~'~"2~' ..........
7. Dimensions of existing structures, if any: Front ./.~'~)~Z~..~Z/.6~, Kear ..... ..~)...~ ...........Depth .,~..~.(~ .....
Height .~..~..~ ....... Number of Stories ............~..~ ..........................................................................
Dimensions of same structure with o,lterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ........ ~..?....~. ................. Rear ....... .~....Cr'.~. ........ Depth ..~...~...~. .........
Height ..~. .............. Numb~er of Stones ......... ~.~..~-~ ............................... .: ................ ./'. ........ x.~;:..r....~l;/~ ...........
9. Size of lot: Front,~-z,,____ __,-,--, z/~-~--'";~'~"'~'" Rear ........ ~.~.~.. ........ Depth ...~...'~.~..~..~...~.......~/~
.
10. Date of Purchase~.~..~.~.~...x~'.~...Z-.~...,4'.,~'.*,~.~.. .......... Name of Former Owner
11. Zone or use district in which premises are situated .................................................. ...2,./4_ ..........................................
12. Does proposed construction vio?~/,~e, any zoning~¢~,: ordinance o~,,u~ation? ...... ,/./.,,.~..//'~' ..........................................
13. Name of Owner of premi~.l~.~.~Address .~..-~J.~;~hone No..~...~...
Name of Architect .................... ..~....~.....~... ............ Address ............................................ Phone No .....................
Name of Contractor ....................... .'~.~--...=~.Address ............................................ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and bIock number or description according to deed, and show street names and indicate
whether interior or corner Io~,~, rl~. ~// L'~J/ _f-/,~'/,~
STATE OF NEW4'YO~q]~, ,q/9 '(SS
COUNTY 0~>.....¢' ' '
(N~me ~ ~dividu~l signi~ application)
above named. He is the .........................................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~nd is duly authorized to perform or have performed the said work ~nd to m~ke and file
this application; ~hat qll statements contained in this application are true to the best of his knowledge and belief; and
that' the work will be performed in the mqnner set forth in the application filed therewith.
Sworn to before me this c
.......... : ........... .............................. . ............. ............................. .............
No, 52-70~7~0
R~s[dinF~uf~ ~unty
Oomh~,;~,on ~xpJros March 30,