HomeMy WebLinkAbout21077-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24216 Date MARCH 15, 1996
THIS CERTIFIES that the building ADDITION
Location of Property 720 BUNGALOW LANE MATTITUCK N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 02 Lot it
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 5, 1992 pursuant to which
Building Permit No. 21077-Z dated NOVEMBER 12, 1992
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 ATTACHED INGROUND SWIMMING POOL AS APPLIED FOR.
The certificate is issued to GENE DOROSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL INSPECTION CERT. #1957 - NOVEMBER 23, 1992
PLUMBERS CERTIFICATION DATED N/A
Buil, Inspector
Rev. 1/81
I'
roam NO. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NN? 21077Z Date 19.92
Permission is hereby granted to:
.J
V~.. '
.
to t rj ......tZ~
.
21
at premises located at ....................GP~
~
.
County Tax Map No. 1000 Section /.;.2.-;~ Block .......41.2;...... Lot No...... /.1
pursuant to application dated 19 3P-, and approved by the
Building Inspector. 1/,19 2°
i
r
Fee 5..........
I
r
ilding I or
t
Rev. 6/30/80
i
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept, of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4, Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwell' bons to dwelling $25.00,
Alterations to dwelling $25.00, wimming =pool25_0s0 Accessor build in
Additions to accessory building $2 50.00. y g $25.00,
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
0
Date ~7..........................
New Construction........ Old Or Pre-existing Building
Location of Property .....7_20
House No. v .~ri a~/.~ .............~<9a`~.7,~{.% f!~>4.......
Street Hamlet
Onwer or owners of Property Q Y.Q? ~
County Tax Map No 1000, Section... 42-A ;,,,,,Block 0.2....... Lot...... /r,,,,. .
Subdivision.. / Filled Map............ Lot...................
Permit No.(07,7yZ Date Of Permit .../f/~ 'A p
p p l i c a n t . 1-JC'/7P .?~U~' ~
Health Dept. Approval ..........................Underwriters Approval..AzJ~ i- ,
cz
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate..1`..,,,,..
Pee Submitted:
C y /l~ A(ICAN. a-T
PPL
q~n~p~n~ 6 n q~nW6 • ~p
w GJ tti WJ%J V~ J tNJ \:1~:! W VoJ WN WJ \°~"J WJ tl~J V~~J p J GV t~
7 7 7 O
n s D
m OT
( o m m p N i N i N C_ w x w
Z. D T N -i m m r 1 N N N Cn w
n v n [ m° x m n N
w m C, CD
7f N j, 3 i 1
3 D y m m O
0 (D
( o o N O N m d N y m W
(a v Z D° 9 = n o~ G N m
m 1~ w d .o x
i = O
D 3
s " N N w rn a 0
m m = 1 H. N p --I >
m CL
? W D n N N J CD N m 'i1I
(a 'm O v y N 0 N D 0
N D m x O N NNI
4,9a s> m n Vca
cn raj -IN
> m D a W O C=
< o y m w A = Ta
f y r N c
'
( ° T 7 O W
' Q Q
p N L-4 1...1 z V
3 Z 0 3 a s CD M
° (D ° In CT
m r W ° Z X °
(o y m ° Ot v Mm O
m T T _ t+
(a v N c z Z i a C+ w S
D ' n v 0* cn
m m ° M D
C N 0 i x y i
N o p m Q o N n
ZN _
n C m
~ m D w w
° 3 T y O D
CL > Z 0 CD C)
o 7 N i y m p w h
m 7C N b 1..1 w
( .w N
a f H n
\ 0 y ro
m
° z D fD 1a>;7 T N )
H m m 3 0 c
n N m m 3 UI T °
3 O x N N
N ~ 9 ~ N
N to
((~(!j~~~))o . (jl
(Y ~~"v16CJlvl'MCNV1Cf~(~vVb2f/vl~C(v1'beD'lvlbNJIvICCNS}tl~c'lfS1E~NXvlMd/vV6c7lvlFatl'1.~i1M~NJ~l~1b~0~v bc7l`u'lb.MfvlMtlRnC
C], ~r 0 i:: S :Z
_ H
"OU1IDATION (1st)
=OUNDATIOtJ (2nd) _
ZOUGH FRAME & II
• II p
.PLUMBING 1
H
II C7
ENSULATION PER N. Y.
STATE ENERGY
CODE
r'13t
7
FETAL n~
ADDITIONAL COMMENTS: s :y\`
x
31
• A
H
p
m
H
m
BOARD OF HEALTH
_r. 3 SETS OF PLANS
FORM NO. 1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
NOV 5 TOWN HALL NOTIFY
SOUTHOLD, N.Y. 11971 CALL
TEL.: 765-1802
MAIL T0:
Examined 199.
Approved 19/.8Permit No.`~!?
Disapproved a/c
( it g Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~ a~........ 19,4-
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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, building code, housing code, and regulations, and to
admit authorized inspectors on premises an&in building for necessary inspectio
(Signature of applicant, or name, if a corporation)
~UrsQ.~7/dcr/ 44. . . ?'bXl Cec • /lQQ 1
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.0
Name of owner of premises ..`S.(T.Nt n IGU...............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. .....&:k I -:N.T.......... .
Plumber's License No. !~lfl
Electrician's License No. -:t?.~
.
Other Trade's License No. ..../U1A........
1. Location of land on which proposed work will be done .
°^J~Lo ;UPI ccl...~- o.Uis vb.A. f&Ok
House Number Street Hamlet
County Tax Map No. 1000 Section ~.a ~ Block Lot ....1f
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of pproposed construction:
a. Existing use and occupancy Sl...~f • • • • • • f~Y1 l~itw,Rf~3j
1f ar80 ac ~W g ,pa dvl ye............................
+i 't*tu l
b. Intended use and occupancy ...5.1• tIf~
i, t t Ape a~~ gx f aaw
3. Nature of work check which a
'G x 3 (I q~ placable): New Building .Addition , Alteration .
em
Re Rpair . 'oval . Demolition n , .Other Work ~
d Se,J(ry, ph /yj pc)ee (Description)
4. Estimated Cost . g1.7C0 Fee
` (to be paid on filing this application)
5, If dwelling, number of dwelling! units A)IM 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 mmber of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth . . ' Height Number of Stories .
S. Dimensions of entire new construction: Front ...(6.. Rear ....1~t J Depth
. u. ber of Stories .7
9. Size of lot: r Front . , , • .0. , Rear ...2 $?.g4,... % Depth . i°6'
.
10. Date of Purchase , 'p . Name of Former Owner
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation: . , d .
13. Will lot be regraded c; s. , Will excess fill be removed from premises: PYe No
14. Name of Owner of premises Address 7 ..&7y0c~, I.{q, phone No.
Name of Architect ! Address f. Phone No
Name of Contractor .
1 ~j®o... .
5. Is this property o alt d IKI,^. ~ Ac?ez. t 'Address y'.7 l?.;j ~'R . ,phone No. 7.44'.
within 300 feet of a tidal el Ift?, ~'Ynes No W
*If yes, Southold Town Trustees Permit mayy~ be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block,! number or description according to deed, and show street names and indicate whether
interior or corner lot.
AP ROV D AS NOTED
DATE: B.R q _:E/_0 7 7~
FEE: BY:
NOTIFY UI NG DEPART
765.1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION '4tN(} REC}UIRE;D
FOR POURED CONCRETE.
2. ROUGH . FRAMING & PLUIVBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N Y.
STATE CONSTRUCTION & ENERGY
CODES, NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
!II
I
STATE OF NEW YORK,
COUNTY OF ..I!7GiePl aL S'S
Sbeing duly sworn, deposes and says that he is the applicant
(Name of individual sig ing contract)
above named.
He isthe........ d C3~
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dujy authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
1_;;o....... day ol r."0vey 19911-2-
Notary Public, County -
VWTORI 4 M. KAt K$MN
Hd" ature applic nt
b, $ue of NOW YlodE
Cud1e lpIn S9 (Sign ature of applicant)
Comm"W Euplra $$A 14; taw
1
U
N
.
Q-14( pGf/ a9i I-`,lki!:rr_r)jATELy
0 SE pOOLTO CODE
~gENCLO
9; U$ONQPO-WATE8
S~00.
O q>, /
QpF X00 0000,
{p `^eq,°+e t•'y,,,~ OLS ~h1 zaz , ~ n
O o` ~
G 7 ~oz LtiW ` o•E \
p is SURVEY FOR
ooh 43 y4i a o A RO ED AS NOTED GENE DOROSKI
OCC~ !8j Y DATE-/j I B.?fi 077 A T MA TTITUCK
Q OC`,v~ Sl S~ 2 ,jo • N;iiFY BUILD OF DEPART TAT TOWN OF SOUTHOLD
i aC\- o a E ~~1 ,4 I^a 4 AM, To FOR THE
m SUFFOLK COUNTY, N. Y.
~Q oe o , C9 r 1000 - 123 - 02 - n
.o &S o Scale: 1" . 30'
Oct. 21Y 1992
F Fr ~6 ~ c ~ - ' 5F r . s5 t, ri
/0 ~t OIL, i UTREP T SHALL 4ti3NY
EET
~
o~ r REO fIREsAE AEN$ OF THE N.Y
3'Q a 0i 34TE CONSTRUCTION & ENERGY
og- QQ u~ a~ ~
m~ Cv h v •O ODES. NOT RESPONSIBLE FOR
? ~o~ X~ sit I h ~00 ''=SIGN OR CONSTRUCTION ERRORS
w
~
Z o C.0
%
O ~a UNIT ^riMR;r'RTIM"A!E
a , m~ of CERTIFIED TO
y GENE DOROSKI
w
Uw P~ f NEW),
a I U c~ ar T. MErrG O•p'f
IAN
07E Il
O` 021
CG: man A f,/ i
n.w S. 86'57'00" W. BB.96'
a Prepared in accordance with the minimum Y.S. L/C. NO. 49618
STREET standards for title surveys as established
CENTER by the L.I.A.L.S. and approved and adopted PBC A "J#
9vo ORS, P. C.
for such use by The New York State Land (5/67 7 - 020
Title Association. P. O. BOX 909
AREA .25,818 sq.ft. sour OLDp N. I1971
92-289
2W a 1 I
un JW W
~r 0.
E ~urv W~W
N i Y I 4_E _ . u t) '4 o
a: ui -s a. >1
U) a z
a z • O
M
a 7 r V I • P, H
so W O J N H
w m It
0 1
W f o (r m Za •os v QW o a w°
4 Y w w a C) z (1. ¢ H H
K
W
0 5. z S O O
J
10-
(L •91 „LZ I 0 'k A,,_ 41"
11 I w to M
w m i I O
ui L_.I u dp p. O
to ix aW
w a: w u aeon s ~o
m _
it m ~ u
o ,)Po a o N
o m a
F M 0
M ui # 9 : E co) j IL W
F MAW w M
Wa a rc
au 0
0 J z
„bl ,L/ tl o
II W Z
O
4 0 I Y
,R' OQ 1'~ 1,' iVQ,p• N F x N .0
cc -fa "
O m
GU ~Z 1`5\ I i J N S JJ
00 OJ W W I 4. O SOJ
W LL Z _II O M
Q G L7 W U J : f J 1-
W Z - - -
W 2 OJ O Z i' Q
mu am-0 M g~
F 2 I OF n
•mw „b ,E N II S arc
w
x>-
d01 : wu.
i
"c L vsa o
_a /{8 ;a 3a
z L/{ L 1 Z
0
• J U
w U W
6t1
M
OZ-
Om Wv
aw F>-J
r ~r, O-~ W3
W
d - ~ o~ N
k L w0)Zo
N ; pow
W
3d~OlS 3dOlS :
I b a
rc
O ,0 ,B o
O
r-°
~ v m
w p
a w Z w //y~1~ O a J 0 O
0 C,
m3O IA _~J ~ a N N
u •Z Z A a`r o N b 00
00 I > a O n9-~L m 0 0 m
~o Q
Z t7 r` Y .r f0
e w J H z co
b /1 1• m O O 4 4 Y V' to
u w O I I i a2 O W G' N N N
j I I W W o m m 0
UZ I Z ,b N U ri m N N
Kap 00
III W a \ m ri N ID O
¢O M M O
L- z
N 0 p
w F M M V
m N W < x x
W
Vl w N D O
' - N i