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HomeMy WebLinkAbout3544-zFOI~M 1~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD. N. ¥. THIS CERTIFIES that the building located at ~.~,..1~I~t~. BOa~ ............ Street Map NO. ~ ....... B~ock No ..... ~ .... Lot No.. ~... ~a~ti~ck.~ .~.,~, ...... conforms substantially ~0 the Application for Building Permit hereto~e filed in this office dated ............. .~...~., 19.6~ pu~rsuant to whi~ Building Permit No..~[~,. dated ............. ~1~.. ]3-, 196~., was issued, and conforms to all of the require- me.nts .of the .applicable provisions of the law. The ~o.ccupancy for which this ce~ificate is (owner, lessee or tenant) of the ~ore.said building. .Suffolk County Department of Health Appeoval . .~..~..].9~.. 7aY. ~. ~t].]~ ....... Build,nE Inspector ~ l~ORM NO. ~ 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? Z Permission is hereby gronted to: ............... .~t&..~s~...~ ........................................ ......................... J,t~l,~..~i,~X,~ ............................ to ]h;t/,l&.m..l~,t~a~..Im~,~.i~ .....C.t,~:~.~...a,1;.~,~ ~,..~.~m,~ ........................... at premises located at ...~.....[~.~..~-~.~ ....................................................................................... ............................... #~.~elr~..~. ............................................................................................ pursua~ to application dated ............................. ~l~lr.....~,~ ........... , 19.G~.., and approved by the Building Inspector. FORM NO. 1 'I~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....................... , 19 .... Approved ........................................ , 19 ........ Permit No ............................ Application No. ?~ ~'~'~ c.[ Disapproved a/c ...... ~ ................. .>.-~ ................... ~'"l" ........ ~ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT D- 19_.0.?. ..... July 13 Qte ............................................................ , 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 od oining premises or public streets or areas, and giving a detai ed description of ayout 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 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. Arth~r Mannale (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ................................................ .g.,o. ......................................................................................................................... Name of owner of premises ...~..~...~..e..~.....~..:...g..~..~..~] ........................................... ' ........................................................................ 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 ........................... .......................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~..a..g.,~.~....]L:.~...~,~ ...................................................................................................... b. Intended use and occupancy ....b,,,,~.,s..~.~.?.,..s.~....~.~,.1.~.~g..,...(_..~.z?.e..~...,s.~p.~.e..~ .............................................. 3. Natu]re of work (check which applicable): New Building XXXXXXX.......... Addition ........ ,......... Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) (to be paid on filing this application) 5. If d~velling, number of dwelling units ..... .~..o...~..e. .............. Number of dwelling units on each floor ........................ If g?rage, number of cars ......................................................................................................................................... 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use .~,~¢,~¢.~2 7. Dimiensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... Hal!iht ........................ Number of Stories ............................................................................................................. Dim,~nsions of same structure with alterations or additions: Front ....................................Rear ........................ Dep:h ................................ Height ............................ Number of Stories ................................ 8. Din' ensions of entire new construction: Front .............. .~..6...-....~...~. ..... Rear ..... 2.,©. .................. Depth ,..0..C)..../....~,,2., He !Iht .................... Number of Stories ........ .o..~...e. ................................................................................................. 9. Sizej of lot: Front ....... ,]....0..0. .............. Rear ...... ~.0...0. ....................... Depth ...... 3,~k3 ................... ]0. Dot, of Purchase ........................................................ Name of Former Owner ..,~¢.~G~(~...~.$.~ ...................... 11. Zon or use district in which premises are situated ....... ~.~..~..[!..~3.'.~.~ ....................................................................... 12. Doe: proposed construction violate any zoning law, ordinance or regulation? ....Z~O ............................................... Nan ~e of Contractor .,¢,~.~.~1~....~¢,~fl, ................. Address ........ ,~.S~%;p ........................ Phone No ................ PLOT DIAGRAM L_ocat¢ cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f~ property li¼es. Give street and block number or description according to deed, and show street names and indic whether in arior or corner lot. See filed ~lans STATE OF COUNTY above nal of said o~ this appli, that the ~ Sworn to t Notary P~ ............... · C...°..~,..~.?..~..°.~..°.?..'.....&...~.~.~.~....F!~..z~...'.&..1...e. being duly sworn, deposes and soys that he is the applic (Name of individual signing application) ed He is the ....~...~..~... ,~.~ /~' ~., -- ..~..~ .~, (Contractor, agent, corporate officer, etc.) ,ner or owners, and is duly authorized to perform or have performed the said work and to make and :orion; that all statements contained in this application are true to the best of his knowbdge and belief; ork will be performed in the manner set forth in the application~f, iSeW tJ~Cewith. afore me this ' ~__~'~ ~'~r' blic,/~.~.~/..cr...~..~..:...L..~~., County'~~""(~{~ature of applicant) NOTARY PUBLIC,~tato of ~w Vof~ / / SUFFOLK COUNTY DEPART~NT OF HEALTH Riverhead, New York Building Permit No. TYPE OR PRINT LEG~LY IN INK Health Department Plan No. /~. Application f.o.r Approval of Commercial Sewage .Disoosal System TO: The Suffolk County Department of Health Date ,~o,'/ I~ Application for approval of commercial sewage disposal system is hereby requested. .... // // *, 14' J * t Location: (Name a~ side of street, a~ ~e a~"distance to nearest intersecti~ street I hereby certify that this commercial sewage 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. (Builder - Owner)' Ready for inspection FOR USE OF HEALTH DEPARTMENT ONLY Inspected by ~,~~ Date 4~/d~--~ ~ Based on the information stated hereon by the applicant and other information made available, it is the opinion of this Department that this system with proper maintenance can be expected to function satisfactorily and is not likely to cause a nuisance, provided designed sewage flow is not exceeded. Structural features ~n~inee~ Date '~ 9,~,~!,,, SCHD - S-13 6/b8 0 O::: o{ ~. H. Boutcber NOTE: · =MONUMENT SURVEY FOR 58 LIBERTY REALTY, INC. MATTITUCK TOWN OF SOUTHOLD SUFF. CO., N.Y. G~RANTEED TO, SOUTH SHORE FEDERAL SAVINGS SCALE: I"= 40' & LOAN ASSN. OF FREEPORT MAY 24, 1968~oN~ ~e, HCE~"~'~ER AND L.O.N O SURVEYOR, N .°~'.S. LIC. N0.12845 RIVERHEAD, N.Y. zl ~TO~ E L.F--VAT I 0 7FW' ~i C~ L_ ot '/g' .= 1:::~ L A h...l