HomeMy WebLinkAbout3854-z TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
OEI~TJFIOATE OF' OOOUPANIgY
THIS CERTIFIES that the building located at ]~/~ Aekerly Po~d La Street
Map No... X~ ..... Block No .... ~ ...... Lot No ....... ~... ~9~4~: .[]rY~'. ....
conforms substantially go the Applicati,on for Building Permit hereto~o,re filed in this office
dated .......... ~*r.~...~O..., 19~. pursuant to which Building Permit No.. ~P~.
dated ....... ~.~ .... ~ ....... 19.~.8, was issued, and conforms to all of the require-
ments .of the applicable provisions of the law. The .occupancy ~or which this certificate is
Steve Do~ski
The certificate ~s ~ssued $o ................. · ...... ~ .....................................
(owner, lessee or (enan~)
of the a~ore.said building.
.Suffolk Oounty Departmen~ of Health Approval
l~O~ NO. ~
TOWN OF SOUTHOLD
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? 385~ Z
Permission is hereby granted to:
............ : ......... ..~..~.~..o.~. .......... .............................
tO .................. ~ ........................................ ~ ...... "'"' ~ .............. ..... ....... : .........
........................................................ ~,~.~..~.. ............................................ i...: ........ ?..~: ..................... -
pursua~,t to application .dated ..ii;i~i....i..: ............ .~.,~ .~.;J~..i .i ..~.~...i..., 19:.~...~.., and approved by the
Building Inspector.
~ee *...~.~.~. ...........
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S: OFFICE
SOUTHOLD, N. Y.
......... ,
Approved ........................................ , l~} .....Permit ~o ...........................
APPLI(~ATION FOR BUILDING PERMIT
Date April 1 0 19.....~.~ ....
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 iot 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, housing code, and regulations.
Steve Doroski
(Signature of applicant, or name, Jf a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....................................... O.w. e.r ...............................................................................................................................................
Name of owner of premises .S.te.v.e..D.o;r. oslczt ....................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
........................................ Lot No.: ...............
I. Location of land on which proposed work will be done. Map No.: xx ~ .....
Street and Number mnd,.,Lane ............. S u.t o&d ..................................................................
Municipality
2.State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....V.9, D.~ll~..,1,~TXc;1, ....................................................................................................
One fam'l d.V.~.ll;~n on S/S & Aec Bid N/S lot
b. Intended use and occupancy ........................~....~. ........ g ............................... ~ ......... ~. ..............................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..... ~..o..v..e.....B...]:.d..g. .............
4. Estimated Cost .... .~...~...~...........'~.. ............................... Fee
1
0o00
(to be paid on filing this opplicatian)
5. [f dwelling, number of dwelling units ...... .o..~..e.. ............... 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 ...2Q.-.~ ............... Rear .....J.~.-..~. ................. Depth ...... .~..O...m~. .....
Height ........................ Number of Stories ..... ~..W..O. .....................................................................................................
Dimensions of same structure with a,lterations 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 ...~O.0...'k. ............. Rear ...... .'1.00...¢c .................. Depth ..... .1. P_~...± ...............
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11, Zone or use district in which premises are situated ....... J~..cl.J.s.¢, ............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............... ~9 ........................................
13, Name of Owner of premises .S..~...e..v...e....D...o.y..Q~.~j, ......... Address ....... .S. 9..u..t...h..o...]...d: .................. Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Nome of Contractor ..~J,~.~,l.t, lJ~J~..~O.~,f~.e..J;'J, ct.'C.¢.:~;~ddress ....... ~J~..'t.t.$.~.g,~]~ ............... Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly oil 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,
STATE OF NEW,,Yg. RK ~ c ¢
COUNTY OF ............. o.o.
................................. ~..~.~.Y.~....D..Q.Y.P.~JfJ, ................................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ....................... ..o..~..rt...e..z'. ......................................................................................................................
(Contractor, agent, corporate officer, etc.)
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 ¢otemenis contained in this application are true to the best of his knowledge and belief; and
dication filed therewith.
that the work will be performed in the manner set forth in the a~
Sworn to before me this ~
......... ~..~. ......... day of ........ ~ ................... , 19.,&.~..
Notary Public, . .... County"'~/~
No 52-0618100 Suffolk Coun~t}l
FOR, M~ :NO. J.
TOWN OF SOUTHOLD
. BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ................. , 19. :
Approved '~ '~" No ~ ~ tI I ~ ~ '.~.~' ~ ~I ~
........................................ , 19 ....... ~. D~rmit ..........................
Disapproved a/c .................... ~:~ ........... ;....~,~.~ .......... ~~-
................... .......................
Application No....?...f....~./...,~.~.fz)'T.~/
AP?LICATiON 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 applicab eaws, ordinances, building code, housing code, and regu arians.
.............................................................
(Signature of applicant, or nome, if a corporation)
.......... i ctle.. ....... outhola .................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises "iSt~'"~O~'~Sk~ ...................................................................................................................
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.: ........... ~ ....................... Lot No.: ..... ~ .............
Street and Number ..~./~..~;eke~.~..j~Ttd....]~j~,,~er ............ J]o~J.t,~o~¢t. .................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... .*~,(~.&~.t~...]..~ ...................................................................................................
b. Intended use and occupancy ........ (~jte...f.~.l~.:j..'i.~..~l~i~.~.~.}~.O~l...JJj~..~..A~/~...~ll~..~J~...~O~ ...........
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................. Removal ............. ' ..... Demolitian .................. Other Work (Describe) ......~..~.~.~!....~.,~41~ .............
4. Estimated Cost . . .~..,~.~ ............ ........................ Fee ..1L0..~.0..0.. ...........................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... .¢lf~, ............... Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed~ ocpupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if ant: Front ,..2~-.~ ...............Rear ......~,~.~ ................. Depth .......~0~.~.. ....
Height ........................ Number of Stories ..... t~.Q .....................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height: ........................... Number of Stories ................................
8. Dimensions of entire new construct!on: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories ......................................................................................................................
9. Size of lot: Front ...$()0...+. ............. Rear .......*100.,.¢~ .................. Depth ..... $2.~...+. ...............
10. Date of Purchase ................. .......... i ............................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated ..... .~!~...d,~a.t, ............................................................................
12. Does proposed ~onstruction violate bny zoning law, ordinance or regulation? ............... D.O ........................................
13. Name of Owner of premises (~.~et.~.e...D. or.¢l~i~;~. ......... Address ....... I~.~.~,b.0,~¢1, .................. Phone No .....................
Name of Architect ....................... '; .............................. Address ............................................ Phone No .....................
Name of Contractor ..~t,~..t,~;..~O~le...l~Ze41~ddress ....... N&1~.t,$.~,O~; ............... Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or~ I~p~s~,~t, and indicate all set-back d~mens~ons from
pw~ePt~r;rY i~rGoirVceo.~re~e~otand. . block number or descrlptio.: ~,~cc~[~ingVto?.v~ .,.,d~nd", ~,-' show street names and indicate
STATE OF NEWYORI<
COUNTY OF
................................. [~.~¢.~.ft..~..C~.f~.~ ................................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
abow: named. He is the ....................... ¢}.~..~..e...~. ......................................................................................................................
(Contractor, agent, corporate officer, etc.)
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 ail statements congained in this application are true to the best of his knowledge and belief; and
that the work will be performed in ~he manner set forth in the a~licotion filed therewith. '
Sworn to before me this
.......... ....... .. o, .........