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Home My WebLink About11752-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin~ In~p~tor Town Hall Southold, N.Y. Certificate Of Occupancy z14853 Date September 5.~ 19 .8.6 THIS CERTIFIES thet the building deck addition . [x~cationofl~ope~t¥ 995 Deerfoot Fath & E25 Moose T~atl, .~.~?~.~.~.Y. ~ No. ~ H~ ~unty T~ M~p No. l~ ~ion .... 1 ~ BI~ O~ ~t ~P.~ ' Subdividon ..... FUM Map No .... ~t No. conforms substantially to the Application for Buildin~ Permit heretoforu filed In this office dated June 16., 198.,2 which Bulldinl Permit No 11752Z .................... , . pursuant to ...................... dated.... June. .....2..5 ,.... ... . . .. .. . . 19 .8..2 , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which thia certificate is issued iii ......... deck addition .to. existing one family dwelling ?'. Robert Doroski The certificate is issued to .................................... .... of the aforesaid buildIng. Suffolk County D~p~rtment of Health Approvnl - .N/,A. N/A UNDERWRITERS CERTIFICATE NO .................................................. Buildinl Inspector FORM' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H~ Y. BUILDING PERMIT ~'F~,I,$.~PE~j~I~' MUS'I~?BE~KEPT ON THE PI~EMISES UNTIL FULL ~ COMPLETIObl OF TI-~ '~RK AU:]'HORLZr~) . . N°. 11752 Permission is hereby granted to: County Tax Map No. 1000 Section ..~.~.....~... ...... Block ...~....~.. ......... Lot No...~..~.....'~.. ...... pursuant to application dated ..~...../.~. .................... , 19.~,~J~. and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted mm to the Building Inspec- tor 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 disposel-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pz'operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 New C on s ~, r u c % i on ...... Old or Pre-existing Building $15.00 Date ...S.e. lL'C....~.. )-.9.~ ~ ........ ............ Vacant Land .......... . .. Location of Property 995 ~eer~2ot ~a't~ & 225 ~oos? T~il,. Cutchogue, N.Y. Hou~ No. Street Hamer Owner or Owners of Property ................................................ ........ .... - County Tax Map No. 1000 Section 105 Block 04 Lot... 007 Subdivision H/o Hoose Cove .Filed Map No. 3230 .LotNo. 9 Permit No. !.1.~... Date of Permit .~.~.Applicant. R.~be~ Do~oski Health Dept, Approval . .. Labor Dept Approval ........... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .X, ..................... Fee Submitted $ 5,00 cash Construction on above described building and permit meets all applicable codes and regulations. Applicant . Rw. 10-10-78 · · · · & · · · · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~ .~...~..., 19 .~..~ Approved .d~.. ~..~...., 19~,~rmit No..l.l.7...~'..,~ Disapproved a/c ..................................... Application NO. I.l .7. .57A. . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date(~./.& .......... ,19 .f.~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~a=l~i~ti~ar~ 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 a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 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,,,l~lal~ing code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necess~ry ins~l~ctions. (Signature of applicant, or name, if a corporation) (Mailing address of appl~ant) State whether applicant is owner, lessee, agent, architect, eng/neer, general contractor, electrician, plumber or builder. Name of owner of premises . .~.~...? lC.CZ...V~..'...[~. ~aQ~..~ 1~/:' . ~...~....~ ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporatS, o~cer) Builder's License No. ~.~/g-~. ....... lumber s Lmense No ......................... lectnclan s Lacense No ....................... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone....~..-~.~.C..~mO'.'~....~.~../~....~...~..~~ ... r55.eg .C. ...... .............................................................. House Number Street Hamlet County Tax Map No. 1OO0 Section .t. ~..~ .......... Block . .~ .~ ........... Lot..~ .~ ......... Subdivision.. ~. ~..~~ ...... Filed Map No > ~. ~.~ ..... Lot.7 ...... (Name~ ~ ' .... 2. State exist~g use ~d occup~cy of pmm~es and ~tended use and occupancy of proposal construction: b. ~tended use ~d oceup~cy ........ ~ .{ ~ff~ ............. ~ ................................... 3. Nature of work (check which applicable): New Building .......... Addition....~. ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ~0 o o l~e~../'~ (Deaeription) (to be paid on f'ding 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 Wp,eof use ..................... 7. Dimensions of ex~ing structures, if any: Front .... ~..~ ........ Rear . .7..~...~.r~il~ Depth.. ,~.G, ......... Height ...... /. ........ Number of Stories../. .................................................... Dimensions of same structure with alterations or ,ad~itions: Front ..... .~/.~. ......... Rear .. ?. ~ ............ Depth ..... zr..4 .............. Height ..... ly. ............... Number of Stories ..... ( ................ 8. Dimensions of entire new construction: Front ... Height ............... Number of Stories ....................................... L; ............... 9. Size of lot: Front ..... /.~.. ........... Rear ..... /.~.~.-O. .......... Depth .. ~.~.s. ................ 10. Date of Purehase I 1. Zone 6r use district in which premises are situated... ~e ,~.~ .,/~2.~'. 2//.~.~ ....... ,.: ........................ 12. Does proposed construction vioh. t~y zoning law, ordinance_ or regulation: .... .~. i~. ........................ 13. Will lot be regraded ............................ Will exee~ ~l be r~mo~l, f ' · Ye~ 14. Name of Owner of premises .~. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Pho~ No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposcd, and. imiicate ~li ~t-heek dimtm~a~ from property lines. Give street and block number or description according to deed, and ~how street name~ and indicate whether interior or corner lot. STATE OF NEW above named. that he is tho applicant is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work ami to make and f~h~ this application; that all statements contained in this application are L-ue to the b~t of his imowJed~ mid b~li~f; ami tlmt the work will be performed in the manner set forth in the application f'~ed therewith. Sworn to befor~ me this ............ / .'"~'~ . . .day of...~.,,.~,.~_. ........... ']9~..~: Notal3/Public ............ ~ .... ~ ._.~ll~County _ ~ . ~ ,