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Home My WebLink About9955-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfi[icafe O[ Occupancy No.Z.l.2.3` ~.1 ........... Date ...H.a.r..c .h..1.5., .................... 19 ..8.4 THIS CERTIFIES that the building Res Laurant Location of Property 8/8 Niddle Road h3&'~ ~ioi ........................................................ street He,~er County Tax Map No. 1000 Section ...... 6.3, .... Block .... .q .......... Lot 2/4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..S.e.p..t: .... .2 .8 ......., 197.8. . pursuant to which Building Permit No.9 ? .5 5.7~ ................ -dated . .S .e?.t.:...2.8. ................ 19.7.8., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Restaurant with addition The certificate isissued to R. Pawlik (owner, lessee or tenant} of the aforesaid building. Suffolk County Department of Health Approval ......... ~,/./~ ............................. UNDERWRITERS CERTIFICATE NO ............ N././~ .................................. Rev. 1/81 Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIERTIFIE:ATE QF or~CUPANP. Y No. F, 2200 Date Aug'~.~t; TfIIS CERTIFIES that the building located at. ~/~... ........................ P~d~ie Roa~ Street Map No... ~... Block No. ~ .Lot No. ~ 8~u~o!4~ conforms substantially to the Application for .Building Permit heretofore filed in this office d~ted ......... ~"~. ~ ~7 , 19. fi~ ,ursu~nt to which Building Permit ~o dated .......... }~e~..aT .... ,1997., was issued, and conforms to ali of the require- me,~ts ~f the applicable provisions of the law. The occupancy for which this certificate issued is BU~as b~i~di~g ~ ~il! Clay ~illors ~m~ge Inc 0wne~ The certificate J~ i~sued k~ ...................................................... (o~ner, lessee or ten.t) the aforesaid building. ,~uly 31~ 1967 by ~Villa Suffolk CounW Department of Health Approval ................................ ~u~i~g ~pec~o~ BUILDING DEPARTMENT ~'~ TOWN CLERK'S OFFICE -~/ .~/r~(_z' ~"/~// . ~ Examined t 19 ........ ,---, .. -*~ Application N ~=-::;:::: :~:::~*~ ............... ~ Disopproved ~ c ............................................................................................ ~ ........ (guildino Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty 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 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 e 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 6amply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if o corporation) ............... (Address of' applicanl;i*''~' ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~....~...Z~.~. ....... ~..l.~'.'~..~.~.....~.~..~;f.~. ....... ~....~.. .................................. If applicant,if a corporate, s, Lg,n. ature of duly auth~cized officer. (Name and title of corporate officer) Builder's License No. ~r~z/w'l -- Plumber's License No. Electrician's License No / Other Trode's License No ............................................... Location of land on which proposed work will be done. /v'~p No,: ........................................ Lot No ......................... Street and Number ..................................... ~...~. ........... ~....~.. ............................ ~.~,~...,~.M/'~..~,~ ./.¢~ ................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............. ~.,~..',~..~'.~'....~.....*~....,~......~.. ....... ,... b. Intended use and occupancy ~,..~..~..,~-~(...~.../J~.~.,..~.. ~.~.]~...~.. ~..~.~.~. 3. Nature of work (check which applicable): New Building.. ................. Addition ............. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... 4. Estimated Cost ...... ~..~.~. ................................... ee c:~ ~ (Description) (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 ...../...~.. ........ Number of Stories ............... ../. .................................................................................................... 9. Size of lot: Front .......... ~.D.~. ................................... Rear ........ ~.~..¢~. ..................... Depth .....~'.-,'~..~. ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. .Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes .f~) No 14. Nome of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ............. ~ ............................................... Address ................................ Phone No ....................... Name of Contractor ....~~ ............................ Address ................................ Phone 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 number or description according to deed, and show street names and indicate whether interior or corner lot. APPROVED A~ NOT D NO~BY'. ED INSPeCTIOns[° 4PM FOR REQ~iR~ 2, FRAMING INSPECTION 3, BEFORE COVE~NG P~PES OF ANy KIND 4. FINAl. WI'I~N JOB COMPLETED t~OT RESPONSIBLE FOR DESIGN QR CONSTRuC'ilOFj E~R~:,~S 5. ALL CON~].Rp,~T~k~. .. REQuIREME[,. ML $i M~ET AND TOWN lriO~,,~. ''Y' STATE Cor~ STATE OF NEW '~3[~1~, .~..~ /...~ S S ..~..~.~ ..................................... being duly sworn, deposes and says that he is the applicant / - (Name o~ ir~'Mdual s~King contracf) above named. I~ / ~ , - He is the ...... ~..~~.~~~~.~¥f~ .............................................. of 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 of his knowledge and belief; and tha'c the work will be performed in the manner set fo~h in the application filed therewith. Sworn t~re me this ~ ......... ....... ................... , ~~~..~.. (S~gnature of a / ~ ....... ~ ~ / ~ ~ Suffolk ~unty No. 52-~792800 ~ ~ ~m~n ~xplres'