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HomeMy WebLinkAbout10719-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zq 3829 Date September 6 19~?. THIS CERTIFIES that the building ...... d.c. 9.k. addi~ci°n- Location of Property ...~.~..05 ............... ~..~.i.~.3:.w..a ~.e.~.., House No. Street Hamlet County Tax Map No. 1000 Section ...... ? ~.~....Block ......... .~. .... Lot 3. '1 Subdivision..~.l.e.~.~..~p.o.c}...Op?.e. ............. Filed Map No...q?.G.~., .Lot No. q 8 conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...J.tm...e.. 3 ........... , 19 .8,0. pursuant to which Building Permit No. f107'19 Z dated ..... .J..u~.e...q~. .............. 198..©. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tlfis certificate is issued is ......... .... 3.e. ck. ~.c~4~;~.o.n., .~.o..e..x.~.~.n. ~..o.n.e..-?.a.m. ~..~y..d.¥?~.Z.~.n. ¥.. ..................... The certificate is issued to ~t[EODOi~E & GRACE ICRLIKOWSKI (owne~ of the aforesaid building. Suffolk County Department of Health Approval ................. ~ .f,/~ ...................... UNDERWRITERS CERTIFICATE NO ......................... I~/,3, ...................... Building Inspector Rev. 1/81 FOI~M NO. 2 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 AUTHORIZI::D) N? 1O719 Z Permission is hereby granted to: ..... ~/~....~z~-.z,c~.~ ....s2. zc ........... .... ,,~z.~.~/~..~o.~,.....~ ..... //~o7 .... ~.q.~zd~.c~ ....... ~ ....... ~z./../~.z ........ /.~......~ .~/~ ..... ..... ~....:~.~z.~.....~ZZ/~ ................................................................ ~, ,~,~,,~ ~o=,,a ~.:~..~. ....... ~.~.~.&~z~..~:, ........................... .............. C~.~~.~ /.X =~z.~....~..: ....... -....x~(~ .......... ~m~..x~. ............................ ~r~.~.~ ,o ~,,~,~o. d~,.d ...~:..~ ....................... , ~, ..a ~p~o~d b~ ~,~ Building Inspector. Fee $~,, .................... FORM NO, 6 TOWN OF SOUTHOLD BuiidJng DeparTment Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thru a~ollcat~on must be filled in typewriter OR ink, and subr~itted in duplicate to the Building inspec- tor ,,'/,tn the following; for new buildings or new use: 1. Final sur,'ey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohic features 2. Final aoorovaJ of Heaitn Deot. of water supoly and sewerage dmposal--(S-9 form or equal). 3. ACprcval of e!ectncal installation from 8oard of Fwe Underwriters. 4. Commercial buildings, Industrial buitdmes, Muluple Res,dances and similar buildings and installa- tions, a certificate of Code compliance fi'om the Architect'or Engineer respons,ble for the building, 5. Subrn,t Planning Board approval of completed s~e plan requirements where applicable. B. For existing buildings (prior ~o Aprd 1957), Non-conforming uses, or buildincs and ...... land uses: ~ pre-existing 1. Accurate survey of peoperty showing all prooerty lines, streets, buildings and unusual natural or topograoh~c features. ' 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Da~e of any housm§ code or safety inspection of buddings or premises, or other pertinent informa- tion required to prepare a certffma~e. .,' C. Fees: ~. Certificate of occupancy $5.00 2. Caruflcate of occupancy on pre-existing dwelling or ]and use $5.00 3. Copy of certificate of occupancy $1.00 New Bu,ldmg ............. Old or Pre-existing Building(X) . z~ ..... =/Vacant Land Hou~ No. ' ................. : ' L ....... ~ ...... ~. · Owner or Owners of Pronertv ~ ~,=~ ................ ............... ......... ...... of ................ ~puc~n~ ~..~V. Health Dept. Approval ........................ Labor Dept. Approval ......................... Ucdee.'zr~ers Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final CertJficat~ ..... - ......... ~ ~b~ ~d s ~00 Construct~ononabovedescr~bed buitdmoand~er~ * " -' , ~ ~ ~ ~ ~_a Q ...... eels au apP~c~l~odas ~d regulations. Apphcant ATTORNEY AT LAW 828 FRONT STREET, PO BOX E GREENPORT, N Y 11944 P~ONE (516) 477-1016 April 11, 1989 Southold Town Building Department Southold Town Hall Main Road Southold, NY 11971 Re: Krukowski to Thomas SCTM 1000-137-04-3.1 Stillwater Avenue, Cutchogue, NY Gentlemen: Please forward a certificate of occupancy for the deck addition on the subject premises (building permit number 10719) to the undersigned at your earliest convenience. I have enclosed my check in the sum of $10.00 for fee to cover same. If you have any questions, please do not hesitate to contact me. WHP/lmt enclosure William H. Price, Jr. TOWN OF SOU~OLD OFFICE OF BUILDIN'G INSPECTOR · P-O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 T,EL. 765-I8(}2 T,h'~s is to advise Fer~~ ~,r~ , ..... :~ ~.=o ~e 300 unaer Bui~din= a f~::~.~:~ tic~.~,~ zs comp:e~ea and co.,,s-e~e ~h_s file it zs necessaPy tkat ~=~..cy be issued. P.~as~ fill out the enclosed ~oPm(s), mebuFn Sa~e to the above o.._c~ wi%h a check fop $5.00 payable to the Town of Soutko!d. Fl~_se ln~zcate to Whom the CePtlfzcate and ac~ange ~zth uhls offzce fop an inspection date. Thank you fop youP prompt attention. Very truly yours, Victor Lessard Administr~ tot VL:ec Enclosures FIELD INSPECTION COMMENTS FOUNDATION (~s~) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY cope FINAL ADD..___~TIONAL._COMM____~S: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1803 ExaminedJl~.~./(~.. ~.~...., 19(~ Approve .... l& .eerm t / Disapproveda/c ..... .......... ...... / (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.//.~.).Tff..~. ........ Date . .~.~Q~& ..~ .... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary.~(g~. · -~inspecti°ns' .... ~~'~ ,~ ....... ..... (Signature of applicant, or name, if a corporation) (Mailing add~s of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... Plumber's License No ....................... Electrician's License No.. ~ff~t~ .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. Z~'J .... ~J~.. ~.....~4~..: .~. ......... House Number Street Ha County Tax Map No. 1000 Section .../..~.~. .......... Block ....F~..~. ........... Lot..(.~.Q..~7~. ........... Subdivision T~./~.~.(~.t~.(.). ~....C~. ~.~'~. ...... Filed Map No.. J..~..~.~- ...... Lot . .~..~.~...~.. .... (Name) 2. State existing use and occupancy of premises an~intended use and occupancy~ of proposed construction: a. Existing use and occupancy . (~...7.~.~.~./.~.~../~t~/f/.X~.-~. ........................... / b. Intended use and occupancy , . .~.t. ~g~.~_~ .... ~./~,~../././.F~. (~ .~.~. ............................. 3. Nature of work (check which ap)licable): New Bui!d!ng .......... Addition ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ......................... Fee .. -. ............................. (to be paid on fling this application) 5. If dwelling, number of dwelling Chits ............... Number o f dwelling units on each tiger If garage, number of cars ..... i ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ................... ' ..................................... 9. Size of lot: Front ........... i ........... Rear ...................... Depth ...................... 10. Date of Purchase ............................ .z~ame of Former Owner ............................. 11. Zone or use district in which pr~mises are situated.../..~ ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..--~ ....................... 13. Will lot be regraded ....~2f~'Q-....~..' ~ .....~, ..... ~,~. g/'.~Lexg.ess fll be removed from premises: 14. Name of Owner of premises .~..q¢'~~. .F'.,-'~-~ ..~.. ................. Phone No.~. D.r./f.? ......... Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ 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 inumber or description according to deed, and show street names and indicate whether interior or corner lot. ' EVC~YORK, ~, ~.STA~[ E OF N S COUN~'Y OF .~.. ! (Name of individual sigi~ing contract) above named. being duly sworn, deposes and says that he is the applicant He is the.. ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly 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 mann?r set forth in the application filed therewith. Sworn to before me this , d : .... .~...'~. .......... day of ~ .......... 19 .o~-~. , ,o l( CoUnty Z/- (Signature of applicant)