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Home My WebLink About8871-zNO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z8023 ...... Date .......... l~ov...29 ......... , 19.77. THIS CERTIFIES that the building located at .. }I/.S. Main. Rd ............ Street Map No..xx ......... Block Noao~xx ..... Lot No.. x~ · · · Cut~ho~te .... N .¥.. ....... cc, nforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ep~; HD..76 pursuant to which Building Per~iit No .... 887.~Z dated ........ 3.e..p.t. 20...., 19.7..6., was issued, and conforms to all of the require- ...... n~ents of the applicable provisions of the law. The occupancy for which this certificate is ~-- ~issued is P..r.~.v.a.t..e..~c.c..e.s.s. qry. g~aSe. ..................................... The certificate is issued to ~heo~.ore. & .El~Lzabe~. Dox'oski ....... Owners ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.:R.., ........................... UNDERWRITERS CERTIFICATE No.. ]~3.1+~0.$b~.. ~[.une..~0...~-~7.7 ................ HOUSE NUMBER . ~2~!~ .... Street ... P,a~n. Roacl.. ~u~;chogue ............... FO~ NO. 2 TOWN OF $O~TSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST 13E KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8871 Z .~nsp?_?tor.. ....... pERMIT iNCLUDES APPROVAL TO REMOVE EXCESS FILL .... FROM ABOVE pREI,AISES BY REG~ADING LOT ~ DRIVEWAY CONSTRUCTION / CEgsPOOL CONS~UCIION ~ CELLAK cONSTRUCTION ~ Permission is hereby gr~anted to: Theo. Doroski . ........... .Y,a;tm..B, oacl, .............. ~,t*,~ho~ ......... ~ld new accesso~ storage building tO . .....;.;; .................................................................................................................................... ~ promises [~ated ~t ..... ~...~.~...~.~.~. ....................................................................................... :~ ................................................... ~g.,~a~ ......... ~.,.~., ................................................................... to ~pplic~tion dated~. ............................. ~_...~. ....... 19...~, and *pprov~ by the TOWN OF $OUTHOLD ~ Buildiog Deportment Towo Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY Instructions A. This application must be filled in typewriter OR ink,, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installat.on from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. ,5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam statement of owner or previous owner as to use, occupancy and condition of buildings 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ..... ............. New B~ilding .... ~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~...~..Z~./~...../J~../~.~.. ......... ~..44r...T~.4~...~-....O..~v~F.~.~ ................................................. O .er Or Owne. Prope ....... ........... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No. ~..~.,~..~/..,~ate Of Permit/..~/~.~.e./,~..~..Applicont .~.,~.4~..°..~..~-~..~....~....~...°..~....~.l~ ......... Health Dept. Approval ............................................ Labor Dept. A~oproval ............................................... Underwriters Approval ~...,,~.~.~.~.../..~.. ................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate~. ....................................... Fee Submitted $ ~..~..4[.~. ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ........ o, ...... THE Date June 30, THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 1977 .~,,p,,ca.o,~ ,¥,,. on y,,e 92os9o N 345014 only the electrical equipment as described below and introduced by the applicant named on the above application number in thepremlses of Theodore Doroski, n/a l~i.n Rd., 200~ w/o ~bo~ ~ne, Cu~chogue,L.[. ..,,~ .~.,.i,,.d 0. June 27, 1977 and/o,md to be,n compliance with the requirement, o/th,s Board, FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES FLUORESCENT DISH WASHERS EXHAUST FANS 6 4 2 6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS --!SERVICE S E I~ v NO OF CC COND A W G NO OF HI LEG PER ~' OF CC COND OTHER APPARATUS: Panelboa~:d/s: 1-4ckt 125amp MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET AWG OF NEUTRAL John Lademann 1200 Harbor Lane, Box 123 Cutchogue, L.I. 11935 Thru cert,f,cc~te must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idenhfled by the, Lic. 2000E GENEaAt MANAGE~ D :redentloIs. FORM l~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, FI. Y. Approved ..........L;. ............. ~ ....... , 19.Z.~.. Permit No ...... ~..~....?....~..~ D~sopproved a/c ........................ ~.....~~' APPLICATION FOR BUILDING PERMIT Date ................................................. 19 ......... INSTRUCTIONS a. Thfs applicatzon must be completely fdled in by typewriter o~ in ink and submitted in triplicate to the Buildif Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pl(n plan showing location of lot and of buddings on pram(sss, relationshtp to adjoining premises or public streets areas, and giwng a detailed description of layout ofproperty must be drawn on the d~agram which ~s part of th~s applicatio c. The work covered by this appl,cation 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 pern shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupan, shall haw: been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as harem describe The apphcant (~grees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit aulhorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bufldc Nome of owner of premise~'Z~..~.~..~...~.-.~..~.., ',~..~...~.~ .Z~.~ ......... D...~......~..~...'~.../~. ~..: ....................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No.....4/~. ............. ~... Plumber's License No. .~.:. .......................................... Eleclncian's License No N.~ ....................................... Other Trade's License No...~'.. Lo:abort of land on which proposed work will be done Map No .................... ._. ...... LaJ,~o ....... ., . ~ ~7,,. 'r-~ 7.~' .... '--g=~ f ,~,~'r~'~"~--- Street and INumoer ........................... /.x....~. .......... .~>. ~. ................ ~ ....................... .~-~'-'-'-~,'~.. · ~ ...... ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisit,ng use and occupancy .~.....~....~......'~.... ............... Z.' .................................................................. b Intended use and occupancy ............................................................................................................... 3. Nature of work (check which applicable)' New Building .................. Addition .................. Alteration ............... (Description) ~ Estimated Cost /~o~) ~ ....k...~. .......................................................... (to be paid on filing this application) 5 If dwelling, number of dwelling units ..,..//ff.~ ................. Number of dwelling units on each floor ...:K..~. ................ If garage, number of cars ..... .-/..¢4.? ........................................................................................................................... 6 If business, commercial or m~xed occupancy, spec~y n, gture and extent, of each type of use ...~.r¢.. .................. 7. Dnnensions of existing structures, if any: Front ..... ~....~. :....3. .......... Rear .¢...¢..~.~.~ .................. Depth .?..~.../ ........... Height ........................ Number of Stories ......... /.....¢,-~, ...................................................................................... Dunensions of same structure with alterations or addmons Front .................................... Rear ....................... Depth ............................... Height .................. Number of Stories ................................ 8 Dunens~ons of entire new construction: Front ......... ¢.~..: .................... Rear ...~..3. .................... Depth .~...~....O.. Height ..... ./~..~ ......... Number of Stories ...... ./. ................................................................................................ 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. WHI lot be regraded .... .~/~ .................... Will excess fill be removed from premises: ( ) Yes ( ) No Nome of Architect .,V.¢.~'ff .......................................... Address ................................ Phone No ..................... Name of Contractor ..47..~(.% .............................................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and red.cate all set-back d~mensions fro~ property lines Gwe street and block number or description according to deed, and show street names and ind~cal whether interior or corner lot L¥ -13 < STATE OF NEW YORK ~ S S COUNTY OF ......... ]~,~,~.'.¥...r ' ............... ~..b,..e..9.~.9.~.~...J~.q~.o. fl~.~ ................... : .................... being duly sworn, deposes and says that he is the applica: (Name of individual signing contracf) above named. He ~s the ...................................... ..o...~....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 rr~ke and ft thru apphcat~on; that all statements contained in th~s apphcahon are true to the best of his knowledge and behef, ar thor the work will be performed in the manner set forth in the apphcat~on filed therewith. Sworn to before me this .... .2...0..~..~. .......... day of ........ .S..e..g.~...e.t~g~.¢.?. ............ , 19 Notary Public, . ...................... Szz¢-£o.l~ ......... County F£1,~SEIH ANN N[¥1LL[ ~ (S~gnature of applicant)