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Home My WebLink About3592-zFORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLEi~K'S OFFICE SOUTHOLD, N, Y. NO.~98.~ ....... Date ................ ~Tariu~y...t .~.., 19..68 THIS CERTIFIES that the building located at . .~t~...I~l~y~ .t~Oa~1 ........ Street nap No. P.e.c.q~.iq. ~iom~>~k~m~ ........... Lot No. )2. .... ~eevnie...~.~. ............ conforms substantially to the Applicati,on for Building Permit heretof~ore f/led in this office dated ............. Allg...2~ .... 19(~7. pursuant to which Building Permit No.. ~9~.g. dated .............. ~.~,g....~.~.., 1~.., 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 . P~i~r.~*je..o~te .frrr~5~{Sr. rt-~4e[,Yr ].l-ig .......................................... The certificate is issued t,o . .P~uI..0~.o~sir~ ........... 0l¢lle~ · · ·,, ~ ' ~ · ~ ~2,' .......... (owner, lessee or tenan~ of the aforesaid building. .Suffolk County Department of Health Approval ...~a~.l.+.r..~.~...by Jl.~..~'&~[].a. ...... Building Inspector I~OEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE ~OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3592 Z Permission is hereby gronted to: Paul. .~,'~ ~ ~..~..~...u....~...~..~,~e ...... at premises located at ...,~.,O.~...~.~..IL.....?.?..C.,O.!~.~'e'..,!~-:~;.~.?.,g. .................................................................... ........................ I,/. _....a... ~.e.~a..~. ~....a..o.~.4 .j..... ,~ ~.q~..e..... ~ ...~ .: ........................................................... pursuan( to application dated ........................... ..A..Ut.~.?...~.9. ................ , 1~..~....., and approved by the Building Inspector. Building Inspector SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da£e Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located . (~ve deed l~cation) have been inspected by this department and found to be satisfactory. District Engineer District Engineer FOF~I NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................... t..k. ................. , 19..f..~.... Permit No.~.....~...~.....~....~. Disapproved o/c .~.~~~ ........ (Building Insp~'ctor) APPLICATION FOR BUILDING PF-RMIT Date August 29 67 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 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 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. Paul 0rlowski (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. Paul Orlowski 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.: Pecon±c Homes , Lot No.: 32 Street and Number ..E../'...~......]-f~?.~...s.....]:~.e. .......... .P..e...a..o.~.J:..c. ........ !~....~.: ................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .¥.~.g.~....~.~..~...~. .................................................................................................. b. Intended use and occupancy ..... .°..~..e.....-P..a.r~.~.~.,¥....~.~..e.-]~..~.z.~.E ............................................................................... 3. Nat'ure of work (check which applicable): New Building .................. Addition .................. ~ move Repair .................. Removal .................. Demolition .................. Other Work (Describe) (to be paid on filing this application) 5. If 4welUng, number of dwelling units ...... .o...~..e. ............... Number of dwelling units on each floor If g~rage, number of cars 6. If I?usiness, commercial or mixed occupancy, specify nature and extent of each type of use ....... .~_.~ .......... 7. Dim;ensions of existing structures, if any: Front ........ ~.0. ............... Rear .......... .~...0. ................. Depth Height ........................ Number of Stories ........ .q~¢. ......................................... Dimensions of same structure with a.lterations or additions: Front .................................... Rear M Depth ................................ Height ............................ Number of Stories ................................ 8. Dir~ensions of entire new construction: Front ........................... T ........ Rear ............................ Depth Heibht .................... Number of Stories 9. Siz~ of lot: Front ............................ Rear .................................... Depth ................................ 10. DaCe of Purchase ........................................................ Name of Former Owner 11. Zor~e or use district in which premises are situated ....... 12. DOel~ proposed construction violate any zoning Iow, ordinance or regulation? ........... EkQ ........ 13. Nafe of Owner of premises .P.~.~t2....0,E.;L.O.~'~$ ........Address .....?...e..o..9..z3..$..o. ...................... Phone No. Nar~e of Architect ...................................................... Address ............................................ Phone No. Na~e of Contractor ...... .s...8:..~.t.e. ..................................... Address ...... .P..e.?...o.~.&.?. ...................... Phone No. ' PLOT DIAGRAM I~ocot~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and whether i,nJerior or corner lot. STATE OI4 NEW YL9~1¢,¢,,,~ COUNTY jOF ................................. Paul Orlowski ................ .: .................................................. ~ ............................. being duly sworn, deposes and says that he is the appli¢ !(Name of individual signing application) abow; named. He is the ~ (Contractor, agent, corporate officer, etc.) of said ox4ner or owners, and is duly authorized to perform or have performed the said work and to make and this appli(~ation; that all statements contained in this application are true to the best of his knowledge and belief; that the wprk will be performed in the manner set forth in the application filed therewith. Sworn to biefore me this C/ ("'J ~IOTARY PUBLIC, State NO. 52-3233120 Suffolk Co:~, Term Expires NlarcB SO, 19~.¢