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Home My WebLink About3558-zPOI{FI ~0. 4 TOWN OF SOUTHOLD BUILDII~G DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. OEI~TIFIP. ATE: OF OOP. UPANIgY THIS CERTIFIES that the building located at .~/.g.p.O~%:rl. i~I'bml2, l/~oa~... Street Map No... ~ ....... Block No .... ~ ...... Lot No. W~ ............................... conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ................ ~..13.]..Y....~.,~ 19.~.~.. pursuant to which Building Permit No.. ~[~ .~ dated .......... ~].t0~,~...2~. ...., 19.6.~., was issued, and conforms to all of the require- me.nts .of the .applicable provisi.ons of the law. The .occupancy ~or which this certificate is issued is .... .p.~[D.~..~..C., .ll..~.i..].~.'y..rlg.¢.llt~i~$ .......................................... The certificate is issued to ~olll~ho].d Pa~'k t)istrici; (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App.r, oval .g[al3.~..~.~'~..~.~)6~] .'i)~~. .R~-.V.~].~a ....... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER/vtlT (THIS PERMIT MUST BE KEPT ON THE ~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' N? 3558 Z Permission is hereby granted to: , · ....... · ...... :..~.*.~,.:..,~.,,.~.:~..,....: ............... ~. ,, to ~.~..~......~a~. ~..~g ............................................................. at premises ocoted ~.~.~}....~;.~..~..'~ ........... ................ ~X.~ : :.,~ ..... ~...,.....: ...................... , ............. .................................. ~a~l~ .............. ............ ........ : Building Inspector.,. .~ee $..~,1...~..~ .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH Riverhead, New York Building Permit No. TYPE OR PRINT LEGIBLY IN IN~ ~A~A~ ~ ~ Health Department Plan No. Application for Approva%~ pf.. Commerqial. Sewage Dis posal ~stem TO: The Suffolk County Department of Health Date ~/?/< ~ ! Application for approval of commercial sewage disposal system is hereby requested, (Name and sid~ 6f ~treet, and nem6 a~d dist~c~ t~ ne~e~ intg~sec~'~treet) Hamlet ~ O3211~ o, ~ , ToE Village 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 requiremonts o? the latest bulletins on~.sew~ge disposal of the ~uffolk County Department of Health. Applicant's Signature Title Address /~,,~.~.,' ~ t~,t..~.~,~,~ J Ready for inspec~igh~ ,, 6:~ ~ ~Buitder - Owner) FOR USE OF HEALTH DEPARTMenT ONLY Inspected by C,,~~ '~-~~ /~>:~?" Installatio~ satisfactory - Yes ~..~,"No _ 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 s~wage flow is not exceeded. Structural features are not included. SCHD - S-13 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .....~.~..~.~......~........,, 19...~..2. Approved ........................................ 19...!]... Permit No. :..?.-~...O~..[....~...... .............. ......................................... (Buildin~spector) APPLICATION FOR BUILDING PERMIT Dote .............................. .......... ..... INSTRUCTIONS a. This application must. be completely filled in by tyt~ewriter 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 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. Southotd Park Dis'~ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Commissioner Name of owner of premises ...~.O.U.~Old...~.S,~'.k...~.i.$.~ ...................................................................................................... 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.: xxx Lot No.: xXx Street and Number .]~/.~..~Q.g.~..~..O,~..~.9.~.....~..°...~.~.....~..°..g.~.~..°...Z.~. ......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....P,~.&~.g....~ .................................................................................................... b. Intended use and occupancy same with utility building 10. 11. 12. 13. Natbre of work (check which applicable): New Building :Y~XX Addition Alteration Repbir .................. Removal .................. Demolition .................. Other Work (Describe) · ~ ~-' 0 none Estimated Cost ...Z .................................................... Fee ......... (to be paid on filing this application) I no~e If c~welling, number of dwe ling units ............................ Number of dwelling units on each floor If g~rage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use Dir6ensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Din ensions of same structure with alterations or additions: Front ....................................Rear Der th ................................ Height ............................ Number of Stories ................................ Din ensions of entire new construction: Front .................................... Rear ............................ Depth Heibht .................... Number of Stories Size, of lot: Front ............................ Rear .................................... Depth ................................ Dat,le of Purchase ........................................................ Name of Former Owner ' "A" dist Zor~e or use district in which premises are situated J DoeF proposed construction violate any zoning law, ordinance or regulation? ............. ~O .............. Na,~e-- of Owner of premises .~..O..V..~...h..°...]:~....~.?..~,~....?..J;-..~dress ........ ~.O...V.~..h..o..1..~ ................. Phone No. Nar~e alc Architect ...................................................... Address ............................................ Phone No. Name of ContractorG...°..]:~..~.~.~.i.,~.~.....~...1.~...~....g..°...~..s.&^ddress ...... ~.O.~.h...°..3r..cl: ................... Phone No. J_ocat property I whether in PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed arid indicate all set-back dimensions nes. Give street and b ack number or description according to deed, and show street names and :erior or corner lot. STATE al NEW YORK, ~ ~ ~ COUNTY )F ,-.~.:['.?.P,~,~¢ ............ ,f ~'~' ...... , .... .~.~,~].,~,Q,V~...~., ..~.~,,,~ being duly sworn, deposes and says that he is ](Name of ~nd~wdual s~gmng application) abow: nerved. He is the ............ .QQ~t~,.$.~.Q~'~,¢.~ ...... of said ay this appli~ that ['he ~ Sworn to t ................ ..2..~... day of ................. e~.'.bl...]:.~. ............ , 19.~Z ~OTARY pUBLIC, SJ~e oJ New York NO. 52-3233120 Suffolk County Term Expires ~arch 30, 19~ applic (Contractor, agent, corporate officer, etc.) ,her or owners, and is duly authorized to perform or have performed the said work and to make and arian; that all statements contafned in this application are true to the best of his knowledge and belief; ~rk will be performed in the manner set forth in the application filed therewith. efore me this (Signature of applicant)