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Home My WebLink About7435-zFO~ NO. & TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O/lice Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ..0~egon. Road ............. Street Map No .... xx ....... Block No.. xx ...... Lot No...~t .... Cu.~hogu~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... J.~l~y...2~...., 19. ~ pursuant to which Building Permit No. dated .......... ju,~.. 2.~..., 19 ~/.b~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~$Va.~. 9~.e..{*~.~lY. ~.~<~ll~g..~'iSh..aqlc~i.~lOla ...................... The certificate is issued to . Hell~cy. D.olaala.ski ..... 0wl~e~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · ~tl, .............................. UNDERWRITERS CERTIFICATE No. pe~:Lng .................................... HOUSE NUMBER . .. 8~.~.y ...... Street .... Oregoa. R°~d ..... Cat~o~ua ......... FOEM ~0. ~ TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFPICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7435 Z Permission is hereby granted to: A. Chituk A/C Henr~ Doma.$eski ........ ¢~tcho~e ....................... , ........................... build an addition on existiz~E dwelling at premises located at ...Q;C.$.g.~.~...~.~8 ............................................................................................... CutchOgUe pursuant, to application dated ............... ' ....... .~.tJl~ ....... ~.......,i...., 19....~, and approved by, the Building Inspector. Fee $..1.,~,.?...0Q.. .......... Building Inspec~r lrORM NO. ! TOWN OF SOUTSOLD; BUILDING DEPARTMENT ~proved {~ ......................... : .......... , ]~...~.. Permit no....~ .................. ............. Disapproved a/c ............. ~..~ ............... ~..::L~ .............. ~ ........................................................................................... ............ / .......................................... APPLICATIO~R BUILDING PE~IT , ~ate ..................... .~.~.....~.~. ...... , ~.~-.....~ ~. ~his a~plic~tJo~ ~ust be ~p~etely filled in ~y typewriter o~ in i~ and submitted in triplicme to the ~uilding~ inspector, with 3 sete of plans, accurate plo~ plan to ~le. Fee according ~o schedulq. ~. ~bt ~b~ show~ bcot~en ~ ~t-~ of~,~i~ ~ p~e~i~e~, rebtib~m~f~ ~re~, and ~iving a detailed description of Jayout of property must be drown ~on the diagram whJc~ Js pa~ of t~Js application. c. The wo ~ covered by t~:s a~hCabQn may not be co~menced befo~e ~s~u~ce n ~ · J~, '~:~ ~ .... ~'~ OP~ ~-~ ' d. gpo pproval of th~s apphcat~on, ~e Bu~ ding Inspector w, ~ssue a Buil~g~erm~o the app leant. 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 Ce~ificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building I~iepartment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sq.uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings,~additions or alterations, or Tar removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises a~d in, buildings for necessary inspections. --~- Ant o~.te Chituk (Signotu~'e 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. ....................... .h. z ] d.~.~ ....................................................................................... Name of owner of premises *tOltl'jy ~;o!ua±~at~z [{ applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Tr~s. L, ice~se No ............................................... 1. Locotior~ of land 9n which proposed work will be done. Map No.: ....', ................................... Lot No. Street and Number .... .QZ.~.~iDz~..z',o~.ct .......~.~I;LO.~.O.¢[t.L~ .............. '. ........................................................................ Municipality 2. State existing use and o~l~¢~f'zef premises and intended use on~ occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ................ .~.at0.~...¥'.~1~/,..~.lJ.~.~.:~i{~.~ .................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... .~..~_~ (Description) 4. Estimated Cost ............................................................ Fee ......................................................................................... (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 ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ...................................... : ................. 11. Zone or use district in which premises are 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 ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frqm property lines. Give street and block number or description according to deed, and show street names and indicete whether interior or corner ,ot. I; t~0~ o~ ~ ~X~l,~_- STA1-E OF NEW YORK, COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................................................................................................................................ ~ ................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; apd tt-.a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ ............................................ Notary Public, . ................................................... County ......... (Signature of applicant)