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Home My WebLink About3065-z?OWN OF SOUTHOLD IIUILDII~G DEPARTMENT TOWN CI~ERK'S OFFICE SOUTHOLD, N, Y. THIS CERTIFIES that the building located at .~./.~...~ii.i. c ee .. Street Map No.. ~ ........ Block No..~ ........ Lot No.. ~.. ]S0$I~i~0~c~...~?.,.~e ......... conforms substantially to the Applicati,on for Building Permit heretof, o2e filed in this office dated ............ A!~I~L.. 2,6, 19.66. pursuant to which Building Permit No. ~06.~...Z dated ........... .A!0~il...2~., 19.66, was issued, and conforms to all of the require- merits ,of the applicable provisions of the law. The .o.ccupancy for which this certificate is issued is . .P. y;l.'~%t~.e, olle. £a~iy..dMall~g .......................................... The certifica!e is issued ~o .lt/al'g~. C41ap.~lt.. ...... GWl:~o~ .......... . ................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App~oval .Atlg,...8~...~.~66...bM... FOP,,M l~O. 2 TOWN OF SOUTHOLD ~UILDI~G DEPARTMENT TOW~q CLI~R[('S SOUTHOLD, N. Y. BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3065 z Date ......................... ~4~.:L1. ....... 26 .......... , 19.~6... Permission is hereby granted to: Eu~ ¢.0~ ..C.Qr~z'.~c.t i~...Co..... A/~.....~e~...~hapin ......... E~..c~.~.....L.~. .............................................. ................ ~i~r~a~ .......................................... to .B. ulld..~ne~..~r~..£'~il.~..cl, w~&,~r~g. ..................................................................................... at premises located at ...I~,..~,~...(~.fl¢,~,.])~. .............................................................................. :i .... .......................................... E .o..u...~.~.o..~.~. ,......~...~.. ........................................................................... i ........ pursuant to application dated .............................. ~,.~ ....... ~,~ ....... i9.(:~.., and approved by the Building Inspector Fee $.~O..Og .......... s-9 SUFFOLK COUNT~ DEPAR~ENT OF HEAl,TH Date Bldg. Permi% NO. 8 1966 TO WHOM IT MAY CONCEH~: The sewage di~osal facilities for a structure located at have been inspected by this Depax~ment and found to be satisfactory. Dis~ri¢~ Enginoo~ ....... District Engineer ' ,'. ) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~. Examined ..................................... .~...~ (:~ , 19 ........ -- ~ Approved ........................................ , 19 ...... Permit No ........................... (Building Inspytor) APPLICATION FOR BUILDING PERMIT April 26 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink 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 description of layout of property 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 a 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 Southo[d, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comp y with a I applicab e laws, ord nonces, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of ap. plicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ................................................ Ce. n.tr~a~¢~ ......................................................................................................................... Name of owner of premises ...k~.a].'Der.....,Cha~pJ,.l% .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....:~.. ....................... ~ ........ Lot No.: ..~ ................. Street and Number ...${i.l~,.C~:.~ek...~. ......... ~(~¢~o.~.~' ' ..................................................................................... '~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use end occupancy ......... .v.a~,a~.~C,...1.at~d ............................................................................................... b. Intended use and occupancy ........ .o..~...e_.~..~$.]..~....~.~..~.].~.$.z)~. ........................................................................... 3. Nature of work (check which applicable): New Building ...Kg,g, ....... Addition .................. Alteration ..... .......... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................... ; ......... (to be paid on filing this application) 5. IF d~celling, number of dwelling units ....9..t?,.~ ................. Number of dwelling units on each floor ......................... If gcjrage, number of cars ................... ~Zt~, ...................................................................................................... , .......... 6. If bgsiness, commercial or mixed occupancy, specify nature and extent of each type of use ......................... 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............... t ......... Depth ................................ Height ............................ ,~Number of Stories ............... ; ................ , 8. Dim~,nsions of entire new construction: Front ......... ~'2. ...................... Rear .......... ~.2 .............. Depth ...... ~."...~. ..... Height .................... Number af Stories .......... ¢~ ........................................................................................ '. ........ 9. Size pf lot: Front .....]r..O..0, ................. Rear 100 Depth .....~D~..~./.~ ......... 10. Datejof Purchase ...........O.g.~....~.,9..~.~ ........................... Name of Former Owner ..................................................... 11. Zone or use district in which premises are situated ...A....,~,1,~.¢;. .............................................................................. 12. Does proposed constrSction violate any zoning law, ordinance or regulation? ........... ~.~ ........................................ 13. Nam of Owner of premises ...1~.,..~.b~.]:)t~ ...............Address ............................................ Phone No ................. Nam of Architect ...................................................... Address ............................................ Phone No ......... ......... Locate property lin whether int~ PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ .~s. Give street and block~ number or description according to deed, and show street names and i'ndical riot or corner lot. ? ..................... ~,...~.,~..~[(.JJQ[~ ........................................................ being duly sworn, deposes and says that he is the applicar (N~me of individual signing application) above named,. He is the ..... ~.Q~l.t;~.fk¢.~.O.T; ........................................................................................................................... [ (Contractor, agent, corporate officer, etc.) of said owne~ 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. Sworn to befo're me this -- ~ , \ , i ........... ...... Notary F ublio, ..~.~r~.Y~,~..~ ,C, zgdn.~,, ~? ~, (Signature of applicar~t) ~/ N~]ii:i~S~t~'te of New York