The URL can be used to link to this page

Home My WebLink About6480-zFORM NO, ,I TOWN OF $OUTHOLD BUff.~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. 7.%696 ...... Date ............. ~e0 .... l~' ..... , 19..7.3 THIS CERTIFIES that the building located at .. ~N/S. P.~ne..~re~. ~0$d, ... Street Map No. mx ..........Block No...~ ...... Lot No.. ~... gutchague .... ~,.Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........Apr~.~....12-., 19.75. pursuant to which Building Permit No .... 6.1+.80Z dated ...........AprSL ... :L3, 19.7.3., 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 .Pri.v. ate..(lne. F~mil~..dwe3.l~ng ....................................... The certificate is issued to ....R.o.b.c~'.t..,!.-...~ .~.gt~.k.~ ........ . .0~n..e.~. .................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) ?. ..... UNDERWRITERS CERTIFICATE No. .1~. ~ ~o~'t' .... .,~.~ .......... Dec...11...197~ .......... HOUSE NUMBER .... 1 .I+A5 ..... Street .. ~.ine..Tree..~ca~ ...................... Building Inspector I~ORM 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? 6480 Z Permission is hereby granted to: ~.o. ~ .e.,r. t...~....~ .s.. .............................................. .............. .c..~t,.~.~.~.e ............................................. Build new one family dwelling at premises located at ...]I/~S..P. ine...Tz'ae..]i~ ............................................................................. ............................................. (~chog~e ....... NA.Y... ............................................................................. pursuant to application dated .......................&j~t~,.....$~. .......... , 19~.3...., and approved by the Building Inspector. Building Inspeltor FORM NO, 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. ¥. 1197] APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, 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. B. For existing buildings (prior to April 1957), 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. Sworn statement of owner or previous owner os 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 3. Copy of certificate of occupancy $1.00 $5.00 Date DECEMBER 14, 1973 New Building ..... ,,~ ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property PINE TREE ROAD, CUTCHOGUE Owner Or O~ners Of Property ..... ..~..0..~..~.~....~.........&.....~.~.~...~...A...~........~.~?.?..~.~..~ ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. 6480Z 4-13-73 ROBERT J. KRUPSKI Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ...... .1..1...-..!.~.-...~.~ ................... Labor Dept. Approval ................................................ Underwriters Approval ...... 1.~.-...1..1..-..~.~. ..................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... 6.00 ~ regulations. Construction on hove described buildin eets · codes a/¢ Sworn to before me t~.~ ..../..~... ..... day of ....' .../..~.~...~ (stamp or seal) 7-- ~'-~ Notary Public . C~,unty RUTH M. MYERS NOTARY PUBLIC, Sterte of Hew Yo~ No. 52.2841400, Suffolk County 0ommission Expires March 30. ]9 THE NEW YORK BOARD OF FIRE UNDERWRITERS CS BUREAU OF ELECTRICITY I---- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIE~ THAT only the el~t~ ~uipment ~ ~scH~ ~ a~ in~ by t~ applicant ~m~ o~ th~ a~e appli~tion numar in t~ p~mi~s of in the following location; ~ Basement ~ lzt FI. ~ 2nd FI. 0 Ut Side Section Block Lot ,~as~.o,.in.,don Dece~er 6 , 1973 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS I~ECEPTAC~S SWITCHES 5~I 36 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. Of FEET OTHER AF~ARATUS= Furnace/s: ()il, Motor/s: 1-1hp E R V I C NO. OF CC. COND. A.W,G. NO.Q~ HI-LEG A,W.G. NO. OFt, IEUTRALS A-W.G. PER ,~ OF CC. CC)ND. OF HI-LEG OF NEUTRAL 1 ~/0 1 210 2-1/Bhp, 2-1/12bp Robert; Krupski Box 866 CutohoD~e, L.I. 119 ~ 5 ~Nm~ MANA~iR 11 Per ' COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant Phone 5. Address 6. 2. Property Village BOX 3. Public Water Company name 4. Lot size: Width feet Leng~x~JA~J feet 10. Sewage Disposal Sy~m: A. 900 ~'KT~on septic tank:2~ecast Subdiv. Section Lot No. 8. Private well 9. Public water Distance to main ][~ (Enter on center plot below) Equivalent Block B. Leaching pools: Number Precast Block Special ~ · If private well fill in blanks below: Tank capacity Gals. 120 Pump G.P.M. Total well ~pth__ Depth to G.W. ~6 Amount of wate~Sin well Test Hole~ Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." ,~-~ Date Signed/ /~-~ FOR HEALTH DEPARTMENT USE ONLY. Based on the~a~on~e~t~d hVerewith, it is the opinion of the Healt-~-~epartment, that an adequat~land satis~ctory Sewage Date ~/~//' ~ Signed S-15 Revised 4/]/72 ; TOWN OF SOUTHOLD BUILDING DE[~RTMENT TOWN CLERK S OF~CE/~,/~ ' ~UTHOLD, N. ~ ~ ~ ~ ~' .' , Remit No ........... .[...~...~.,~ Di~r~ed a/c ...................... ~... ...... ......................................... ............ ........... Examined ./. .., Approved t I APPLICATION FOR BUILDING PERMIT -, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted iB triplicate to the Building Inspector, with 3 sets of plans, aCCurate plot plan to scale. Fee according to schedule. ~ b. Plot p an show ng location of lot and of buildings on premises relationship to adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on diagram which is part 0~ 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 off 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,rtificate of Occupancy shall have beel~ 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 and in buildings for necessary inspections. (Signature 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. O~ G~B]RAT~ COII"~&CTC~ · Name of owner of premises ..,~0..~.~...~......~,,,1~.**..~.. ......................... ~i~ ........................................................................ If 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 Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... Street and Number ...... ~.....'~.....I~.....~..~z.....G~...?.~Z....~..'...~..'..!....~..'..?..e. ........................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and o¢~,upancy .................................................................................................................................... b. Intended use and--°C%pancy ....0...]~.....?.~....~.~ ............................................................................................ Nature of work (check which applicable): New Building ..... ~, ............... Addition ..................... Alteration ............ .~., Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) ~ 4. Estimated Cost ....... ~b.O~O ...................... Fee ............... i~ ~f'iii'r;~' ~'1~ i; ' ;'1~ ~ii'~ ~'t'i'~ ;~'i ................................. 5. If dwelling, number of dwelling units '"'6 .......... Number of dwelling units on each floor "]~t11'-~¥..~1~..~ ........ If garage, number of cars ........... ~ .............................................................................................................................. 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7, Dimensions of existing structures, if any: Front ..~lii~[~ll... Rear ",~l~, ............... Depth .~..~..~1 Height ........... ~! ......................................... Number of Stories '"~1 ....................................................................... D mens ons of same structure w th a terat ons or add t ODS Front Z. .... 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~ ...................... Rear ......... ~ ........................ Depth .............. ~ .......................... 10. Date of Purchase ....~.~ ....................... Name of Former Owner 'f~l~(3~"~"~J~ .............................................. 11. Zone or use district in which premises are situated ......... &~'Z~i"~-'tt~B~l~'.~ ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~1~ ............................................ 13. Will lot be regraded ..... .~O ......................... Will excess fill be removed from premises: ~] Yes [ ] No 14. Name of Owner of prem,ses ..... ~'{~'.P"~'~'"l~t~ ...... ~l~d~ll~i'~X~l~"~{~';~l~l~ ....... Name of Architect .........~'~1~1~"31~"~ ............................... i~;J~'~'s';i ................................... iF[u'~;~"~'~;i ............... Name of Contractor ..... .~&~-.~..~4)~'~ ............................... i~,~'~')' ................................... i~'~;~'~'~;i ............... 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 wheth- er interior or corner lot. STATE OF NEWYORK~, ~. // ,~ · ) SS COUNTY OF ............... ~ .......... i') ........................ ;';;'"'~'~'~ ................................ being duly sworn, deposes and says that he is the applicant above named. t,var~ o! tr, r~,vtdu~ si~f,g ~.tract ) He is the .............. ~...~ ~ ................................................................................................................... (Contractor, a~ent, corporate of~cer, etc.) of said owner or owners, and is duly authorized to ~rform 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~lief' and that the work will be ~rformed in the manner "t forth in the application filed therew~h. ").:~ ~ ~) ........... ......... ........... ................... ...... ,/// e~ RUTH M. MYERS ' ,, ' Notary Pub c ~~, ~ .TARY ~B~.~,,N. ~~~~/~' J ' ............. ~ ......... ~:'SZ-2~I~ ~01k ~a~' r ........ ~.?-t ~.v. 7.~ ................................ ~ ~mmi,i~ ~irm ~ ~. lg ~ (~at~e of a~p~cant) ~&.b Ave,',= ~O,.'~G9 ~,,~. $c~1,~ = 4~0'=1'' COUNTY ~EALTH ~ TM ~' DE~ Al The sewage disposal and ,-o+ fac~,St::es for this lo~?:!on have been inspected by' this department and found or -'~ ~htef of General Engineering Services ¢ '4o.~o t ~ n ~. 70 ~OAD 0~ $cel/~ : 40'=1" ;I It I t I I _¼ I Z L~O. I- I ILI~' it°