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Home My WebLink About4001-zFORM ~0. 4 TOWN OF SOUTHOLD RUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. r.£RTIFICAT£ OF O[::r. LIPANP. Y No..~3 ..... Date .............. ApZ~....2~[ ..... ,1969. THIS CERTIFIES that the building located at~/8 .J[~:[a~.~ek .La, ~..~.P..~o~e~ Map No..~......... Block No...~r~ ....... Lot No. :~ .... Pe~,$ .... Nm-~, ......... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ............. A~lgUS~..Sbt, 19~. pursuant to which Building Permit No. ~. 'Z' dated ......... A~ .... ~.~ ......, 19.~8, was issued, and conforms to all of the require- merits .of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is ..... I~l~,[IOl~. btl~.t~l.~g .................................................. The certificate is issued t.o (-owner, lessee or~enan~] of the aforesaid building. .Suffolk County Department of Health Approval . ~pl~]...¶~..1~.. :by. Ii,..~].~. ..... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4001 Z Permission is hereby granted to: C/O Le~..~se:l~.....Rt~.....l~o~..128 ...................... ....... I~tt£tu~ ......... ~I~Y~ ............................... to ~.~l.~t..mm..r..~.~.~..l~.l~t~...(..X:l,.ua. doa:.l~,~l.1} ................................................ at premises located at ....::~l~..~acls...l~-r~.A..~Pr~t~Z-~ ...................................................... ................................. l;'~e l~.te, ............ I~...1~., ......................................................................................... pursua~,t to application dated ............................ ~J~ .......... ~.~..., 19..~18., and approved by the Building Inspector. JJoJ~,! Sub,leer ~ "off stl~et parkLug'! ozz,pz-em:[ses. Fee $...~ ............ Building Inspector S~FFOLK COUNTY DEPARTMENT OF HEALTH Riverhead, New York TYPE OR PRINT LEGIBLY IN INK Building Permit NO~ Health Department Plan No. P~--~ Application for Approval of Commercial Sewage Disposal System. TO: The Suffolk County Department of Health Date ~ ~5 ~ Application for approval of commercial sewage disposal system is hereby requested. (Name, sid& of street, name and distance to nearest intersecting street) Hamlet p¢_C.,i~ ¥!. t C.. , Town S ¢- ,.?I' L ~.' 16-~, Village I hereby certify that this commercial sewage disposal system has been constructed in accordance wit~ plans approved by the Suffolk County De- partment of Health on (date)P/~/~and with all the requirements of the latest bulletins on sewage disposal of the Suffolk CountY Department of Health. Applicant's Signature Title (Builder - Owner) A~dress ~',*£ /~ ~77 ~;o~,~,~k Tele. No.'7~-~r'f/ Ready for inspection Inspected by Installation FOR USE OF HEALTH DEPARTMENT ONLY ~..4 - , ' Date :~ satisfactory - Yes L/ ; No Based on the information stated hereon by the applicant and other information made available, it is the option of this Department that this system with proper maintenance can be expected to function satis- factorily and is not likely to cause a nuisance, provided designed sewage flow is not ~P~ 1 S Date exceeded. Structural ACHD S-13 6/58 features are not included. Distriot ~ngineer TOWN OF SOUTHOLD .~' /'J~ ~ 6 ~ : ~ ~. l'~t-- 0.~ BUII~DING DEPARTMENT ~/~,~ /~,~T) ~ ~ ~'~ ~ TOWN CLERK'S O~I~E ~ ~,' ~ ~ , SOUTHOLD, N.Y. ~,~,~ ~ ~ O. '~ ~ ~pp~ ~...~.~.~.~.~ .......... Approved ........................................ , 19 ........ Permit No ........ :... Disapproved a/~....~ .... APPLICATION FOR BUILDING PERMIT Date ........... ~..~..~.. ................. 19...~...~- .... 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 appli~:ant. 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 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, housing code, and regulations. ..... ,¢ .......... .......... ........................ ............... ......... ~/~C n/e~'~4 ~ I~'.'Z-~s~s(Signature of applicant, or name, if a corporatian) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ........... ............................................................................................................................................................. Name of owner of premises ....~....~..~..w...~..D...~.~./ ............ ~z..~..~.c.~...~..~'-4'.~./~. ...... ¢ .......... ~.....~ ............... :.~.~ If ~plicant is a corporate, signature of duly authorized officer. e (Name and title of corporate officer) l. L~ation of land on which proposed work will be done. Map No.: ..~ ............. ; ...................... Lot No.: ........................ Numbe r ~.~ s J~..... ~.9. ~ Street and ....... .......... ~ ......... ~C. C ~.~ .(. ~.,....~R ~.~ ...R ~......~. u.~.~ ~./~ ... /3 ~ ~ [.~ -- M6nici~li~ 2. State existing use and ~cupancy of premises and intended use and ~cu~ncy of propos~ construction: a. Existing use and ~cupancy ................................................................................................................................... b. Intended use and ~cupan~ ................................................................................................................................. 3. Nature of work (check which applicable): New~:Bui}d~ng L.......~... ...... Addition .................. Alteration .................. Repair ............... ~, Removal ..................Demolition .............. .... Other Work (Describe) ........................................ 4. Estimated Cost ..... /...,~.~.~...o...O. ............... i ...... ".:. .......... 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 .~-~.v..~..c...~ ............ 7. Dimensions of existing structures, if any: Front ........~J~ .............. Rear .....~...' ................ Depth ..,~ ............. Height ..~. .............. Number of Stories .... .~.. ...................................... :: ................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~,...O. ........................ Reor....~...~.. ................. Depth ....~. ~.. .............. Height ..,Z.~ ............ Number of Stories ....... ../. ............................................................................................................ 9. Size of lot: Front ..... z'.~,.~../. ............ Rear ..../..A,...~..~ ...................... Depth ..../.~....~..../. ............... 10. Date of Purchase ....~..~..u..s....~........~./.../...k'.~.~.. .......... Name of Former Owner .~..~.~.C.~.~...~'.......~.../?..~.,~.z,=.4~. ..... 11. Zone or use district in which premises are situated ....... ~f..:.~.c..¢.:.~.c..~.~.r.~Z ............................................................ 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ........ .~...~.: ........................................... 13. Name of Owner of premises ~F.....,T~,~.t.~,.¢,.~.~xr~Address ,~'..~.x.../.~['.,~z.~c.~/~.mC.+/Pl~one No. ~..~..q.~..~....-~ Name of Architect ............................................ .......... Address ................................ ./.~.¢..~....~.. Phone No ..................... Name of Contractor ....~..~.~..¢.......~.~.....~.~..~...c. ......... Address ...'~..e~,~..c....~.~......~.~Z...¢~..... Phone No. ,7,~..~..Z..~...~...~.2. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. '~ STATE OF N~il~ Icc cou w ..... ............ ~ ~ ~,,*,,tl ben dusworn ................... : ............................................... ' g y , d~oses and says t~t he is the applicant (Name of individual signing application) above named. He is the ......... .~.*.~.~n~ (Controctob o~ent, co~orote officer, etc.) of sold ownor or owners, ~nd is dul~ outhori~ed to perform or hove performed the s~id work ~nd to rake ond file this oppl[c~tion; that ~11 stotements contoined in this applicotion ore true to the best of his knowlod~e ~nd holier; ~nd thor the work will be performod in the monnor set {o~h in the opplicotlon flied therewith. Sworn to bofore mo this ...... ......... o, ..... ................ .. ............................. ............................. No. 52-91560C~3