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Home My WebLink About3071-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. [3ERTIFII~ATE OF EII-:.OUPANOY No. F,. 2~.38 .... Date ........... l~ove~be~. · ~6.., 19 THIS CERTIFIES that the building located at .N/~ .~ .ROe41 .......... Street Map No. :l~ ..... Block No....:~ ..... Lot No. ~ ..... ~01~;1~l~..N,]/-, ..... con£orms substantially to the Application for Building Permit heretofore filed in this office dated ........... A~r:t~l.. L~, 19.~ pursuant to which BuiIding Permit No. ~0~ .Z. dated ............ 2.p~'~ :~...2~., 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 .~t~s~eSs .B~.i.~.di~-. ,,..~t~'e~..a~l. ~££ie~ ........................ The certificate is issued to .IIs~'~]~d. ~se. .~'~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Building Insp~tor FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3071 z Permission is hereby granted to: ~e.o....Ah.z.~.~ ~...h ./..c...~..[~.zg~...~..e. ................... .......... .C.~g~g.((g.e. ................................................. to ..~.~....n.~[..~.~.~..~...~.~%l~i~....-..(~.~.o.~l...q~;ZLc.~) ................................................. at premises located at ..~..~......~..~.1~ ............................................................................................... ........................................ ~.o.:~h .o. ~..~.~..... N,.i~ ... ..................................................................................... pursuant to application dated ............................ ~.~.~ ....... .~. ........ ]~...., and approved by the Building Inspector ~Et AI~ siEn~ subject to per~it~. SUFFOLK COU~frY DEPA,~I~,~ OF ItSALI~ Riverhead~ Hew York TYPE 0K P.~INT LEGIBLY IN INK Health Dcpo, rtr~nt Plan No, Bu-q[ding Permit Apnlicat. ion for Aporo_val of Corm~ercial Sewage. Disposal System TO: The Suffolk County 0epartmcnt of Health Datq~, F~ / Application for approval of commercial sewage disposal system is hereby requested, (Name and~.~id~ of stre0t~ and name and distance 'oo neareot ~ntersect~no street) Hamlet ._ ~ ~) _~2~[_~ ~__~__ Town I hereby certify that this cmmuercial sewage disposal system has been con- structc5 in accordauce~th piano avprove~ ,by the Suffolk Co~ty Department of Health on (date) /~/~/~ ~ and wivh all the requirements of the latest b~letins on scwage ~]po$~l of the E~folk County Department of Health. Title ~:~ ~~ ............. ~ ~ (~er - Owner) Inspected by, ~-~a~'~/ ~'~ In~talla~zon satisfactory - Yes .. D~PA ~T~L~ ONLY Based on the information stated hereon by the applicant and othS'r-information made available$ it is the o oinion of this Department that this system with proper maintenance can be e;~pected to function satisfactorily and is not likely to cause a nuisance, provide¢ designed sewage flow is not exceeded. Structural features are not included. Date $CI-~ - S-13 s/5a 'FOI~,M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Por~it ~o ............................... D~sopproved a/c .......................... ~.~,.,,~ ............. ~ .............. :~~ . Application No ..... ~.~.....~...2../. ........ APPLICATION FOR BUILDING PERMIT Dote ............. .......................................... , .... 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 ~ocation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust 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 progress of the work. e. No building shall be occupied or used in whole or in part ~or 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ........... ................................... ( 'g o ~pp ' , or name, if a corporatio~i", ....... Nome of owner of premises If applicant is a corporate, signature of duly authorized' officer. (Name and title of corporate officer} 1. Location of land on which propos,~//r~,~', //~)ed w~ork will be done. Map..~...c;~..No.'~__~/, ................................ Lot No: .................... Street and Number .z..~.~.....~...:.r. ............................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy .............. ...~..~.........~.......~..!.~. .................................................................... 3. Natqre of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repa~ir .................... Removal .................... Demolition .................... Other Work (Describe) ................................... 4. Estimated Cost ..........;.~.O.j...O..¢...O. ................................ Fee ....................................................................................... (to be paid on filing this application) 5. If d~elling, number of dwelling units ............................ Number of dwelling units on each floor ............... If gdrage, number of cars ................................................................................................................ 6. If b~siness, commercial or mixed occupancy, specify nature and extent of each type of use 7. DJm~[nsions/ of existing structures, if any: Front .......................... Rear .......................... Depth Heigpt ............................ Number of Stories ......... Dimensions of same structure with alterations or addltJons: Front ................................ Rear Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ............ ~.~. ........... Rear ....... ~..~/.....~.. ......... Depth Heiglht .......... ..~../. ............. Number of Stories ........... ~ .............. 10. Dat~'l of Purchase ........................................................ Name of Former Owner ]1, Zon~ or use district in which premises are situated .......... ..~.~ ..... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ~ premises ..~. ~ ................. Address ,/~r/~¢~,A S'~q'A~./.~.. Phone No. ]3. Nan~e of Owner of ....................................................... ~o ~.~. n ]L/.~ ¢s ........................... Ad tess -- PLOT DIAGRAM L.ocat~ clearly and distinctly oil buildings, whether existing or proposed, and in~ e oll set-back dimensions fn property I/has. Give street and block numbers or description o~and si ~w street names and, whether in~erior or corner lot. STAI'E Oi NEW ~01~ .,, Z ~ S S i ~ ben dui sworn de oses and sa,,s that he is the ann, · fName of individual signing ~p~l~t].o~/ of sa d o~ner or owners and is duly authorized to perform or have performed the said work and to make and .hr, ~Ni~:at on' that all statements contained in this application are true to the best of his knowledge and ~'~'~ ~'k~c~t ~'he w~rk will be performed in the manner set forth in the application filed therewith. Sworn to ~e/)f,~ me this · 2?. FJ .] It I1- II'~ .%, . ! il T ~ "/ >' T T L I I