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Home My WebLink About12655-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAR~MENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17559 Date DECEMBER 5~ 1988 THIS CERTIFIES that the buildinqADDITION Location of Property 275 HAMILTON AVE. House No. County Tax Map No. 1000 Section 137 CUTCHOGUE Street Hamlet Block 05 Lot 18 Subdivision RAVATONE REALTY Filed Map No. 539 Lot No. 19 conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPT. 29, 1983 pursuant to which Building Permit No. 12655Z dated OCT. 1, 1983 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 DORMER ADDITION TO EXISTING ONE FAMILY DWE. IJ~ING. The certificate is issued to EDWARD P. KREBS & DOROTHY BURDULIS (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N029319 AUG. 24, 1988 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FO~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12655 z County Tax Mop No. 1000 Section ...... !....~....-].. ....... Block ......... ~ ........ Lot No ....... I....~. ............ pursuant to application dated ...~~.......~...~ ........... , 19.~....~.., and approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEPT. ~N OF SOUTHOLO , Instructions This application must be filled in typewriter OR ink, and submitted ia alJaamma to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unu~al natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple R. esidence$ a.nd mm~tar b~?d~ngs and installa- tions, a certificate of Code compliance from the Architect or Engineer responmble 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: I. Accurate survey of propertv 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: J. Certificate of occupancv New Dwelllng,$25.OO, 'Accessory ,.$10.OO [{usil~es,, $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10,00 ~.Vaca.t L~.d C.O. ~ 20.00 8..~f--.f:~ /~,/:t.~.7 5.Updated C.O. $ 50.00 Date .......... 6. )~lteration $25.00 ~ NewCons truc ~ion ...... Old or Pre-existing Building ........ ~.. Vacant Land ............. ........... .... Locatio. of Prop ./~ d ............... ~ ..... .C...U. ~ .F.C. ~ ...... E. House No. Street Ham/er Owner or Ownersof Property .... ~ .~. ~.V,'~/~. b. · .~ · A~(..~'.~.~. "C ....... ~0./~,, .'~.0/~,~.' ' 6/.~..~'..pO/Z-Jr County Tax Map No. 1000 Section / :5 ? ..... Block .... ;'~.~ ........ Lot. / S Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./',~.. ~ ,~. ~ ?.'. Date of Permit ./.~t/(. ~.~..Applicant..~..4/. Health Dept. Approval ........................ Labor Dept. Approval ........................ Request for Temporary Certihcate ..................... Final Cert~f)cate ..... 'y ............... -~..~- .c, f Fee Submitted $ ...... [ ¢. Construction on above described building and permit meets all applicable codes and regulations. Applicant ............................... ~FIE~D INSFECTION COMMENTS FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN HALL SOUTHOLD, N.Y. ! 1971 TEL. 765-1802 'this is to advise you that the job under building permit no, 12655Z issued to Elizabeth Krebs on _~.Q~,1/83 ~_ for Addition is completed a final inspection has-~ ) has not ( X ) been done. and tn order to complete this file, it' is necessary that ri Certificate of Oecupaucy be issued. Please fill out the enclosed form, return same to the above office with a cheek for $25.00 payable to the Town of Southold. Please indicate to Whom tho Certificate of Occnpancy is to be mailed, and arrange with this office for an inspection date 0ccupaney or use is unlawful without n Certificate of Occ.paney. Please. help us to clear up thi[ mstter so that legal action does not have to be taken. Thank yon for your prompt attention. Victor Leeward Executive Administrator VL:gar encl. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ~...~..% .I .... , 19 ~.~. Approved ........ , 19~.~. Permit No../?-../0..S~.~..-~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ... 2.'7.~. ~. .... a. Tins 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 whatdver 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 regulation_s, and to admit authorized inspectors on premises and in building for necessary inspections. .. ~-'~ ~ o,o..~.~.~.,z~.. ~.-T~...<. .............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,~ con--electrician, plumber or builder. ·. 55¢z~.../~ ,~-..~.~.,..~77~..¢.,..., ~..~..~.~. ~.~. ..... ~.~.~.?.~.~ .~...~..~ ...... o owner ofpr mises .· .................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nmne and title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done... ~...~..~-'fl~...: ...................... ' ........................... House Nulnber Street /' 1~ ........................ County Tax Map No. I000 Section . ,~'.~. ~. ........... Block . .~. .............. Lot...,~.~. ............ Subdivision. ~../~..,~.' .~-../~'.S&~. ~/.~.~.. ........ Filed Map No... ~5."'4~· ~.. ...... Lot .... ./. ~. ....... 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~ristructi~n: a. Existing rise and occupancy .... .//.~..~ ......... i'.:. .......................... b. Intended use and occupancy .,~:~i~-e . ~ .~ ~ ..................... 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ ~..~. 0 ~ ....-------- (Description) 4. Estimated Cost ................................. Fee .~..~.., ................................. /f ~ ..~ (to be paid on filing this application) 5. if dwelling, number ofdweiling,'units.. . Number ofdweliing 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. D~mens~ons of ex,sting structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... ;.. Height .... 8. l)imensions of entire new const[uction: Front ',~)'")-~'C~''~ ...... Number of Stories ............. ; ....... ......... , ..... Rear . .~.q ./.7.o. .: .. Depth . ./~...o. ..... Iteight Number of Stories 9. Size of lot: Front .......... i ........... Rear ...................... Depth ...................... 10. !)ate of Purchase .......... ! .................. Name lhf Former Owner ............................ 11. Zone or use district in which premises are situated ......... /.".~q-. ~; ....................................... 12. Does proposed constructipn vio!ate any zoning law, ordinance or regulation: ~ ............................. 13. Will lot be regraded ../'.U..~ ..................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises~.Z, ~'.~ ~:-~.. Address .,5/,,,~r~.if~,~,~. ~.~t~' .... Phone No ,?~. :Y'.: ~.~ ~' ts. Name of Architect ....... Address ... .~2'~. Phone No' . . ' ..... Name of Contractor:~'~9.~..., (~,~.~ ._~',,~o..~,Au..~ Address l~.q .7.~A~g~e'q...~.~.¥.. Phone No. ~ ~.~.. ~..~..o..~./.. PLOT DIAGRAM Locate clearly and distinctly al buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and blocki number or description according to deed, an~t ~names and indi?te whether interior or corner lot. ~, ! ~ Q~ STATE OF N,EV~..~.O..rRJ~a ~ ,. S S cou*TV ..... ;. /./ (Name of indff/idual sign'ing contract) above named. .......... being duly sworn, deposes and says that he is the applicant He is the ...................... i ..... . ............................... i (~Contra~or, agen~ ate office ) .... ,corpor r, etc. of said owner or owners, and is duiy 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 bo performed in the manne'r set forth in the application filed therewith. Sworn to before me this i / ............... · .d/~..q ...., 19 Notary Public .' . . ' ~ ~u. a~zaaoa. ~uUo~k Couuev,~ (Signature of applicant)