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Home My WebLink About3619-zFORM NO. 4 ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI'CE SOUTFIOLD, N. Y. OERTIFIEIATE OF OOP. UPANBY No. Z 3073 .... Date .......... May .20 ........... , 1968, street THIS CERTIFIES that ~he building located at 8/8. Pin Map No .... ::.. [Block No ........... Lot No, conforms substantial~ly to the Applicatlon for BUilding Permit heretofore filed in this office dated ... ~.. :Sept, .. 9 .... . , 19.67. pursuant to which Building permit d~ated ....... Sept....11 ...... , 19.67., Was isstled, and conforms to all'of thb requir'e- ments of the applicable provisions of the law. Tho occupancy for which this certificate is The ccrti£icate is is.sued to Ben ,'1%. D:rlltk61t.. o.~rtelr ................. ~ ...... .,.... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' ' Building Inspector FORM NO. 2 TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT, ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3619 Z Pej~mission is hereby granted to: to pursggn~., -, to,,,application dated ................... "' ;'~ ~ ~"' ,t~ ............... ; 19.~, and aPproVed by "th Building Inspector. .Fee $....,~,~,~{~ ....... ' S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Da.te May lh~ 1968 BldE. Permit No. 3619Z TO WHOM IT MAY CONCERN: The sewaEe disposal facilities at Pine Neck Road, Fairview Park~ Southold for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. ~ner - Pe~n T. Driskell Builder - Leo Kwasneski PlU~ D--OAD LOT-I LOT-2 Br~ T ~P oF L~MD FO I;:Z B.. Di2tSk;LLL. 50UTi4OLD ,t viu TU. YL ~ eo~ FORi~I NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEI~K'$ OFFICE $OUTNOLD, N. Y. Examined ........ Approved .............. Application No.....~...~..../.....~. ........... Disapproved a/c ....:]..~.~.~.:...~. ........................................................................ · ............................ APPLICATION FOR BUILDING PERMIT 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 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. ................ ................ (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. 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.: ~f~ Lot No.: ~Z Street and Number ..~Z~...~..~.~..~g~:~..~...~.~.~'.~_.~.~ ........... ~.~-.~ .................................... Munici~lity 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 o~e Pa.m~ ~fe]~ NotiJre of work (check which applicable): New Building .... ~.X... Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) Estimated/ Cost .... .?e..~.~...0..0...0....~./~.~ ............................. Fee ....Z..0..,.0.Q ....................... j (to be paid on filing this application) If d~,elling, number of dwelling units ....... .o..~..e.. .............. Number of dwelling units on each floor If gj~rage, number of cars ..2,..~.~;~ ................... If ~ usiness, commercial or mixed occupancy, specify nature and extent of each type of use Dirt ensions of existing structures, if any: Front ............................ Rear ................................ Depth Hei!lht ........................ Number of Stories Din asians of same structure with alterations or additions: Front .................................... Rear De :h ................................ Height ............................ Number of Stories ................................ Dirt ensions of entire new construction: Front ......... ~'2. ...................... Rear ....... .~'2~ ................ Depth ...... ,,~.Lj: ....... Height .................... Number of Stories ...QP,.~. ................... Siz~ of lot: Front ......... ~. ............ Rear .................................... Depth .....3,~.0. ................... Datp'l of Purchase ......... ..3,.~..~.~. ..................................... Name of Former Owner .... ~.Q.hl.J;[;.O.~.ql,..]~).e.¥.o ...... Zo!e or use district in which premises are situated "A" d±s~ Doe~ proposed construction violate any zoning law, ordinance or regulation? ........ .!50 .............. Na~e of Owner of premises ....~..~..rtJ..,.....D.~..:~.~.~.~.~......Address ....... ~.0.1~1.~.b.0.~ .................. Phone No. Nor~e of Architect ...................................................... Address ............................................ Phone No. Nal ne of Contractor ..~.~..o....~..y..~.~.p~.~.~.k.~. .................... Address .......... ~.0.~.¢,17tf~Q ............... Phone No. 10. 11. 12. 13. Local property I whether i.n PLOT DIAGRAM Is, whether existing or proposed, and indicate all set-back dimensions names and ~er or description according to deed, and show strTt ? clearly and distinctly all buildin, nos. Give street and Block numl :erior or corner lot. STAI'E O~ NEW YORK, [S S COUNTY/OF ..... ~.0.~,~2 ..........~ · · of No (Signature of applicant) Notary Piblic, ,. ~ Leo Kwasne ski .............. , ................................................................................ bein9 duly sworn, deposes and says that he is the applk [(Name of individual signing application) above narhed. He is the Contractor (Contractor, agent, corporate officer, etc.) of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the w,'ork will be performed in the manner set forth in the application filed therewith. Sworn to I~efore me this