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Home My WebLink About3716-zPOEM 350. 4 TOWN OF SOUTHOLD BD'ILDING DEPARTMENT '1"OW1~ CLERK'S OFFICE SOUTHOLD, N. Y. P..ERTiFII~ATE DF DCP-UPANi:Y THIS CERTIFIES that the building located at .H.~.~..b.o.l~...L.~..n.e. ................ Street Map No ............. Block No ............. Lot No..C.~t~:C.t~0g. tl~,..Iq..e.~...Y.o.~.k .......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ....~l.o.v..e..m~..e~....1.~.~ ...... 19..6.7. pu.rsuant to which Building Permit No. 3.7..J-.6. ..Z.. dated ...~.o?.~..1~..e..t....2.~., .......19.6.7. ., was issued, and conforms to all of the require- ments .of the ~applicable provisions of the law. The .occupancy f. or which this certificate is issued is .... ~.~.~.v.a..t.e.. 9.n.e.. ~a..m~.~.y'..d.~..e.~.l.~.n. 9' ....................................... The certificate is issued t,o .. ~l.~OD.e..&..~o~.175~..])O~bek ............................. (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Appr~oval O..~.1:.o..]?.e.~., ~.9.~..~.$.~.8.~:~t.o.~.~t;..V.~.~.~.~... Buildin~ Inspector TOWN OF $OUTHOLD 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? 37 6 Z Permission is hereby granted to: at prem ses ocated at J~!~ ~J~t~. ~ .................................................................... pursuanrc to application doted .,.........................,,..~_~.......,.~......., 19.,.j~, ,and approved by the Building Inspector. Fee $.~.Q ~,.0~. .......... ' Building i;;spector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date October 29, 1968 Bldg. Permit No. 3716Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at w/s Har~r Lanes C~tcho~e (Give deed location) have been inspected by this department and found to be satisfactory. Builder - Chef Orlowski Owner - kntone Dobek District Engineer ~ District Engineer .... ,. FORi~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEEK'S OFFICE SOUTHOLD, N. Y. E×om,ned ....... .......... Approved ........................................ I9 ........ Permit No ............................... Disapproved a/c~~.~.~zz~.,~~.~ ...... Application No.....~....?../[..~.. ........... APPLICATION FOR BUILDING PERMIT Date ~..~....../.. ~. ........................... 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 location. 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Ad,ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 wjJl be done. Map No: ..~..~.~...-~1,~..~.~...~/.... Lot No: ................ ./... Street and Number ...I.'~~.....~..~..?.~ .......... :~ ........ J...~..*...y: ................... Municipolity 2. Store existing use ond occuponcy of premises ond intended use ond occuponcy of proposed construction: a. Existing use and occupancy.....~..~...~ ................................... ~-Z ....................................... b. Intended use and occupancy, i...~.......~.'~:~z'~......~"..~....~mC...../~z.~,::.~........~....~ ....................... 3. Nature of work (check which applicable): New Building ...... ...~. ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... ,~..O../..¢2..-~.....'7~ ........................... Fee .......... ~....~....r..~ ........................................................... (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 .............................. 7. Dimensions of existing structures, if any: Front ............................ 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 ......... ~,.)~...~ ....... Rear ......... ~....~ .......... Depth ....~,~ ............. Height ......... L~.f. ........... Number of Stories ,...~ ............. 9. Size of lot: Front ........ L~,..~ ......... Rear .......... ~.~..~ ......... Depth ......... Z..~..~...~..'. ]]. Zone or use d~¢Hct ~n which ~re~ses ~re ~ffu~t~d....~.~ ................... ~ .............................................. ~2. Doe~ ~ro~o~ed conCrucdon v~ol~te ~n~ zon~n~ bw, ordinance or re~ubdon? ..... ~...~. ................................ ' ~ r ~~ ~' ' Phone NO 13. Name of Owner of premmes ......................... ~.~dd ess ..................................~ ........................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor..~..~~ ....... Address ............................................ hone~ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) 5 S. COUNTY OF ............................ ................. ~...~~ ........................ being duly sworn, deposes and soys that he is the applicant (Name o{ individual signing application) above named. ~e is the ................................................ ~..z ...................................................................................... (Contractor, agent, corporate officer, etc.) o{ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best o¢ his knowledge and belie¢; and that the work will be performed in the manner set forth in ~ a~lication fl[ed~er~itk. Sworn to befqre me this ( ~ (/ ~ · &0..~. day of }.X .~v,~'~ 19 ...... CD~A~l~ature of applicant) ........ , k , ) . NOTARY PU}~LIC, State tn /;nl¢ ...... z ...... , ..... '¥"'~ ........ '-" '- (~ ' ~erm Expres March 30,