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Home My WebLink About4512-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.Z .1~268 ..... Date ................ 14a~,... 2.'~ ·., 19..7.~. THIS CERTIFIES that the building located at . .E/S. ~reak~ate.r..P~ ...... Street Map No. 'X,~X ....... Block No .... X~ .... Lot No.. ~xX ..... ~lattttuek.. It,I. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Oct ....18..., 19.69. pursuant to which Building Pemit No..b512Z. dated .......... Oct .... 20. ., 19.69, was issued, and confoms to all of the require- ments of the applicable prowsions of the law. The occupancy for which this certificate is issued is . ltel~giaus. Building...(Church.) ...................................... The certificate is issued to ..~ G.~eek. Ol, th~dex- Church. ~cie~;~*' e~l' ~i:l,N®$ ~ ..... (owner, lessee or tenant) of the aforesaid building. NO~'~ A~ldit~,onal work after may 27 1971 will requtr~ Suffolk County Department of Health Approval .l~a~'... 2.~...197.~... by..R .. ¥.llla .... apprev&l House ~ 1950 ..... Building In~c~r ........ TOWN OF $OUTHOLD BUt[DING DEPARTM~T Town Clerk's Office $outhold, ~. Y. Certificafe Of Occupancy THIS CERTIFIES that the building located at .I~/.S .Br~akwa~.,~r. Rd ...... Street 'Ma~p No..~. .......... Block No....~. ...... Lot No...~......~..t..t.i.t.u.c.k....N....~.o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........0?.t....~.8...., 19.6.?. pursuant to which Building Permit No.. dated ...........~.c.t. ..... 2..0.., 19.6.~., 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 .... .H.e.1..~.d.i.o.u..s..b.u.i..1.d..~.1~ .... C..k~...~.. ................................... The certificate is issued to ~celc .0rth~clo~c .Ctmr~.J~.. society..Qr .D~.QCeS ..... .o~e~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval , .~...~.~. ~ .1.c~,~...b. 7. ~ :..V.~.]:.l.a. .... UNDERWRITERS CERTIFICATE No..l~.n..d.~.n.~ .................................... HOUSE NUMBER .... 19~Q ..... Street.. Br. eak~.ter. ~o~ ..................... Buildin~ Inspector 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? 512 Z Permission is hereby granted to: ................. ~lmath~lel ............ llj2I., ..................... at premises located at ..................... ]~....~ms/~lkt~Lti~.....~;~O.~t~..~[~[ ................................... ................................................ lta~t~tuelc ....... t1,~ ......................................................................... pursuan¢ to application dated ............................... ~.~ ......... .~j~ ...... , 19~.., and approved by the Building Inspector. ~ee $.~......?...~ BUILDING DEPARTMENT ~/'~/?~ TOWN CLERK'S OFFICE ~ ' ~ '~ ~ SOUTHOLD, N. Y, ~ .... _Application No ......................... Approved ........................................ , 19 ........ Permit No ...... .' ..................... Disapproveda c ..... APPLICATION FOR BUILDING PERMIT - Date ..................... ~[ .................... , , 9.~....~..... 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 premisesI 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 port of this opplication.~ c. The work covered by this application may not be commenced before issuc~ce 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 H.EREBY,/v~DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South01d, 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 oil applicable laws, ordir~ences, building code and regulations: _ , (Signature of applicant, or name, if a corporation) ..... ( ress o applicant) ~/ S ' ' ' n r lessee a ent architect en ~eer enera contractor electr~oan Ju ' ' ~ tote wnether applicant is ow ·, , g , ' , g' ., g , ' ' , p meet or ouilder. ~. ....... ...... ........................................................ ................................... 3 Name 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 proposed work will be done. Map No.: .................................. ' ...... Lot No.: ............. ..~. ....... ?/ Municipality 2.State existing use end occupancy of pre,es and intended use and occupancy of proposed construction: o. £xisting use and occupancy ....... ~..~...~.. ......................................................................................................... b. Intended use and occupancy ~-//~O~:~ C~, 3. Nature of work (check which applicable): New:'Buitding '.~ ....... Addition .................. Alteration .................. Repair .. ................ Re~'al .................. : Demolitior~....,..;.,....;.: Other Work (Describe) ........................................ De r 4. Estimated Cost ....~j.~..~...O. ..................................... 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 .............. 7... ............. '. ............................... ~ ................. ~: ........................................... : ............. :,. 6. If business, 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 a.lterotions or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ S. Dimensions of entire new construction: Front ....... J~..~:...'. ............... Rear .....~.~...~. ........... Depth ......~....~....~. ........ Height ....~'-'~.~ ....... Number of Stories ....... ~.~........o. ........................................................................................... 9. Size of lot: Front ..... .~.~..~.. ........... Rear ....... i..s~..¢~ .............. Depth .......~.......~.../.. ............. 10. Date of Purchase .............. Nome of Former Owner ....~?~....~'...~....~'.~.......~'...~....~'.~.~....~...~..~'./' r 11. Zone or use district in which premises are situated ....... .~-./. ........................................................................................ 12. Does proposed constru~ti0n ~late__ ,,,= ~'~,*, .~any zoning law, ordinance or regulation? ...... ....~....~.. ............................................ 13. Name of Owner of premise~J~'-~e['.~...(~.-..~....~.~.x~.c...'r~.Address ~..~..;~...C~..~....c...~. .......... Phone No..~ ....... Name of Architect .~...~.~..~..~.~...~....~.~.....~..~..~..~..~.....Addres~....~.~ .~..°. '~'"~';~...~..'..~..~ ....... Phone No?~..~..'...~..~..~.~ Name of Contractor~.//.'.~....~l......~.~...?....~..../.~....Address ....~...o..?....'~...~..q...A:....~.~../~..~.., 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 block number or description according to deed, and show street names end indicate whether interior or corner lot. · STATE OF NEW YORK, e 1,¢c .COUNTY OF .......... ; ..................... ~'~' e.8' ~':i: ............................... ~ ............................................................ being duly sworn, deposes and says that he is the applicant . . (Name of individual signing application) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfOrmed the said work and to rnoke and file this application; that all statements contoined 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 inrthe app ication fi ed therewith. Sworn to before me this ......... ......... Notary Public, .~.~..4/ County (Signature of applicant) nRr PUBLIC, State of New York NO. 52,0§18100 Sufi~olk Coun Oommi~Jofl [xplree March 30, 19~ SUFFOLK COUi'f~Y DEPARTP~NT OF HEALTH Riverhead, ~,]ew York Building Permit No. tYPE OR .[RINT ~E~LY IN ZIK Health Department l~_an No. Application for Approval of Commercial Sewage Disposal,,S, ys, teTM, TO, The Suffolk County Depart, ent of Hca!th Date, ''f'~/6~_. Application for approval ~f commercial sewage disposal system is hereby requested. (Name land side of street, and name and distance to nearest intersecting street Village I hereby certify that this commercial sevmge disposal system has been con- structed in accordance with plans approved by the Suffolk County Department of Health on (date) and with all the requirements of the latest bulletins on sewage disposal of the Suffolk County Department of Health, Applicant's oienature Title (Builder - Address Tele. No. Ready for inspection I~spected by ~/ FOR USE OF t{E_./~LTH DEPARTmeNT ONLY Installation satisfactory - Y,;', _ ~ -~ ¢ No Based or. ~he info~aation stated h~-eon by the applicant and other information made available, it is the opinion of this Department tha~ this system with proper m24~,,~nc.e can be expected to function satisfactorily and is not likely to cause a nuzsance, provzded ~smz~~$ ~lnw i~ not exceeded. St~ctural features are not included. ~}~i}']7 il '~' ? ~l'll t97 E ", , , . Date _ .....~f. .2 ~, "' ~ U ['.., ,' _ Chief of eenera~ ~g~ne~,'l,~ 2~;~i;c= SC~ - s-13 STATE OF NEW YORK, } ¢ ~ COUNTY OF ................................ ,f ~'""' ................................................................................................ being duly sworn, deposes and says that he ts the applicant (Name of indwidual signing apphcation) above named He is the ................................................................................ ,,. ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file Ibis application; that oil statements contained m th~s application are true to the best of his knowledge and behef; and that the work will be performed in the manner set forth in the apphcat~on filed therewith. Sworn to before me this .-,. ~._.~ _ ......... .~ ........... day of ........ ~..~,~..,. ..... ~.~ ........... , ~...~.~ '~-~ J ,~/ --)~. ~ ' :,.,: ...~ ....... ~ ......... , ................... ~IOTARY P~LIO, St~'e of ~!~w ~r~ No. 520618~00 Suffolk County Commission Expires ~arch 30,