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Home My WebLink About10544-z FORIII NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREIv\IS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N<J 10544 Z - JO Date ..VAi.Jf.l.Cjf.cy...~../~.." 19....,.. Permission IS hereby granted to: . . ...(!I6E/a:..X'/X(/f2$~l', s.c:. .,;/.2o..50....I:IAlM..ICl.?.: " ...." ., -iik-o.,f,.I,6,.c..;riJ..y..:....... .. ..".., , I to .~~7/CCl.CT.....~/Z;c.G, 4.7Ct/.x:.AL..... ~Q:t:.6?7'#.2..]$LP7..' ................................................................................ ...... ",. ........... ........,......................................... ot premises located at7/...dJ1:J.$Q........&A/..u...A;::::>c:2....................................... .,..,.......,..... ....,.....',............... ...".............................",.......,.,..... .:Il=.CQN.t..(..;...J...<. .~......... ....,...........,.. .............................................................. ............. ..... ....................... .................................................., pursuant to application dated :J(it.,V.I?t1:.~ .. if!.. ..,... '" ., 19.&., and approved by the Building Inspector, ~<.Jo Fee $..1. .....:.:::-:...... ('1 /~i.. . Building Inspector i 1 i. ,]t. . .11." FORM NO.6 TOWN OF SOUTHOLD Building Department Town Hall Southold, ~~.Y. j 197i APPL/CATlO0J FOR CERTIFICATE OF OCCUPANCY InstructIOns A. This cDDlicatlon must be filled in typewriter OR Ink, and submitted in duplicate to the Building Inspec. tor '.'Iltn the following; for new buildings or new use: 1. Final ,urley of property with accurate location of all buildings, property lines, streets, and unusual nJ::LJ(,j! ()~ tooocraohic features 2. FlnJI 2ooroval of Heaith Dept. of water supoly and sewerage dlsposal-(S.g form or equal). 3. Appro'lal of electrlcai 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. Suomlt Planning Board approval of completed site plan requirements where applicable. 8. For eXfst;"g buildings (prior to April 1957), Non-conforming uses, or buildings and upre~existjng" land uses: 1. Accurate survey of peoperty sho'Ning all property lines, Streets, buildings and unusual natural or topogr<.1pnlC features. 2. Sworn stJtement of owner or previous owner as to use. occupancy and condition of buildings. 3. Dale 01 any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. I C. Fees: 1. Certificate of Occupancy $5.00 2. CertIficate of occupancy on pre.existlng dwelling or land use $5.00 3. Copy of certificate of Occupancy $1.00 August 05, 1985 Date.. . . _ , . New Building............. Old orPre.ex;sTing Building(X). -.1--- .-./Vacant Lend -............ LocatIOn of P;operty :380.30.MlI.in.EQ~q. .(Rt,.. .~5.),.............. ... .':'~~~11~~..... .,.......... House No. Srreer Hamlet Owner or Owners of Property .... .~~I:?~rt Kr~T!~~~'._.;>r.., , . . . . . . . , . . .. . . . . . . . .. . . . . . . . . . . . . Count'! Tax /vlea No. 1000 Section.. .. ,......... Block............... Lot................ SUDdivlslon. . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .Filed Map No. ......... .Lot No. ............. Porml ' 10544 Z . Do,-:' 01/15/M ^ _ "__. Albert J. Krupski, Sr. . t ~o. .......... O~~e of, ". "".. ......... ,,"""\!-,f);!vODL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ......................... Undcr.'uiters Approval. . . . . " . . . . . . . . . . . . . . . . . .Planning .Board Approval. . .? . . . . . . . . .. ' ., Request for Temporary CertifiCate.................... .Flnal Certificate.......:......... _ Fee Submitted S . . .~ . . . . . .$.5...0.0.. 'left .,::?7.Q/.P,. . ConstructIOn on above desCribed bUildlng~n permit meet14a" ppl.i,cabl~odes and regulations. C,oA\' W-Y:' h A Ilcant, ....... . ~. '-1\D, pp . "'. ~"......;...... ............. Re.... 10 1078 ..... .,....:.:7:";.f:..~~.~....:.... ;', '.':~ ... : , . "j" ~< j d ! i FJELD JNSPECTION JJATJc; CU1VllVllilHo; . .. . '-\; 'D 1. ~~ :::J~ 1----- ~ JOUNDATION ~ --.11st) 13'(( N I~~ FOUNDATION (2nd). ~~ 2. ~ ROUGH FRAME & ~ ~ . PLUMBING ~ UJ~ 3. q ~ _ ill INSULATION PER N. Y . ~ ~ STATE ENERGY COOE ~1 ~ Q~ 5ft 4. ~0 ct' IT~ - ~ ~ >-1 ~~ ADDITIONAL COMMENTS: >j '\ Y\' '~ --- "- ~~ , I~~ ",1 ~ >j " P1 lJIl ~ I g~ , ; ':J1 ill I. , ~ I ill ~ . , ~ " } , t.. ii..l .: ,j,'!1 _",,_,- , 1> , -.... ~ -, "'.-. . I" ~~ . TEL. 765-1802 TOWN OF SOU lhOLD OFFICE OF BVILDI:\G INSPECTOR 110"; ,I 11,',- PO, BOX 728 ~! " TOWi\ H,\LL :~I AW "Sl~ Il1JI' SOUTHOLD. N.Y. ] 1971 BLDG. DEPT. TOWN OF SOUTHOLD QQ~ ~ph ~, - Applicant .~ 1!t) :? () Yvt' rU ..J . _10 .\.L I ~- Jt<"'_c')~L I ,.,,\;<:v.--s De~,r ~ \{ Mt-(sL : Th~s is to ac.vise that the Build.lDg Per-wit No. 1../"" on \\ \'t\~l:) for: -- COr:1:J2.et.ea 2r1d a f.l~al .lnSp6ct2o~ been done. In oreer to camp le:.e this file, it is nec'2ssary ..:....... +- .....c:.1..o a Cer'tlficate of Oc:::u~a!1cy be 2..ssued. Please f~ll out ~he ef!closed forr1( S) 1 return S3f.le to the a~ove o:~:.lce W.: th a check for $5.00 p2ya~le to the Town of Southold. Please ~ncJ..cate to whom the Certif:!..cate of Occupancy is to be r:ai.lec, and arrange wl.th thls off'J..ce for an inspecfion date, Thank you for your prompt attention. Very trUly yours, \eeL -....-Y ~~~c.' L "--Lt, Victor Lessard 1f?'1 AdI!lin~s~rator VL:ec E4"lClcsures '/1tW. ~, 4~ ~ <t ckth._~dD httk~.. .vk~ ~ rk, ~udv1 tY~M7 tlikd; ~ iv. ..38'c>,'j() ~ ~ ;J~ ( 11 ~ /'9;,(f. '_ f~ ea1t. ~ a& 13t{-(Pf'f1 JJ ~ ~~~ AC0v 4V~ ~ ~A~""1!4-:,'i!1 ii,. I " , -. , . u.,. " .:. '.'3,',. A :, 1-, ,. ,.'..l'"->A. ',.'0" 0 I " /.4... FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ /-::> TEL.: 765-1802 . '~tU up<!_ CJ.... ,. /OS-dd Exammed V('i.. :1...,.,.., 19<JY ApplicatIOn No. .. . . .. 7:-~. . . .. . . .-.- 1.5 (]>. ' Z APprovedJ,<?p ,/:"f" ", 19([d.PenmtNo./O$~~.- D. d I .----- Isapprove a c , . . . . . . . . . . . . , , . ., ..,.. ~ .... APPLICATION FOR BUILDING PERMIT ~ Date -:.)c(f1'f.(<rr . . !~. ., 19 ~ INSTRUCTIONS 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 Penn it. d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or m 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 Pennit 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. - J ~ ' I- .....QJkd..~.,.. .. .. ~....'.'..... (Signature of applicant, or name, f a corporation) .f(.t2.~~.. ,..1T.c>..3Q.lJ.z"':"";{;.<<.l.j,!L,NP:j?k... (Mailing address of applicant) /(7""15 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . /JW /J tZ.tf. ' . . . . . . , . . . . . . . . . . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . , . . . . . . , . . . . . . . . . . . . . Nameofownerofpremises .IU-.t!F:/!.T:,.X.. K~~I!'S.K.(", ..f~""""""""""""""""""'" (as on the tax roll or latest deed) If applicant is a corporation, sIgnature of duly authorized officer. ................ " '........................... (Name and title of corp~rate offic ) -=-> Builder's License No, .,.. .. . .... . . . . , . ., ' Plumber's License No. ....... .,.....,.,....,. Electrician's License No, ".,....,.......,...,. Other Trade's License No. .,...,.......... ..., I. Location of land on which proposed work will be done. .,...........................,..",..,........... , ,.,J,'ft)..?Q, , . , , . . , . . .. . ,miff1/. ,1?~IJl).. (tr.:..o?~J ' . . .. . .. . ?~t;.o.lJ/. U;, . . .. . , . . . , . . . .. House Number Street Hamlet County Tax Map No. 1000 Section. a.%'.5:: .".,... Block. ,<?'..$.,.......... Lot .'99.<Y.........,.. SubdivisIOn ..'". ....,..,...,.,...,........... Filed Map No. . . , , . . . , .. Lot .,...,..,..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. EXIsting use and occupancy . . . .Il. G:1f!.1. c. v. f,.. (,<!/f.i3: . . . . . . . . . . . . . . r ' . . _ . . . . . . . . . . , . . . . . . . . . . . . . .5(0 P /l G - F/L:>p / ~ /' l);;:. b. Intended use and occupancy .......... (', . . . .'./;. . . . . .n,.V~. . .lvJ/'-'~. 'I' . . . . . . . . . . . . . . . . . . . . . . . . , . I j, . <. l ~ 1~_ 1. ;;ji; ~ f, I'J. \.., \. 3. Nature of work (eheck which a~plicable): New Building. ... ... .. . Addition.. .Y. . .. .. Alteration .......... Repair .............. RemQval . . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . !/>; ~ o-P (Description) 4. Estimated Cost. . .. 76,. ~ .'. .. . .. .. . . .. . . . .. .. . .. . . . Pee. . . ':;'-'.~ . . .. . .. . .. . . .. . .. . .. . . .. .. (to be paid on filing 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 type of use . . . . . . . . . . . . . . . . . . . . . , ~ ' J I' , 7. Dimensions of existing structur~s, if any: Pront . . .:f. . . . . . . . . . . Rear ..7.'.;2........... Depth. q'l,cl . . . . . . . . . . . Height .,;;.1:.......... NUn]ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Pront .. fl.:? .'. . . . . . . . . .. Rear.. .'11.:;2. ~ . . . . . . . . . . . Depth. . ".2. ~ . . . . . . . . . . . . . .: . . Height. . rl ~ ~ . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new const~uction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ., . . . . . . . . . . . . . Height ............... Nurrjber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . . . . . . . .'. . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase .. .t.'/. tf..t:. . .' . . . . . . . . . . . . . . . . . . Name of Former Owner ..T:. .1?.I.tf.r:"h . . . . . . . . . . . . . . . , II. Zone or use district in which pr~mises are situated. fJ. ~.IU. <: Y. ':- .r: <(1f.1? f.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ...v.~ . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded '" N 9. . ). . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes @ 14. Name of Owner of premisesA~i;jI,6"/i(r.. <<~."'f.:s.l(r, ..r:~" Address P,/(}(IJI. 'o\:~1' .1?if!"p(l/,I.c, . Phone No. 1..3. 'I. :-.'i 1".'1.7. . . . Name of Architect ..........'.... . . . . . . . . . , . . . Address .. . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . " . . . . . . . . . . . . . . . . . Address ... . . . . . . . . . . . . . . . . Phone No. ., . . . . . . . . . . . . . PLOT DIAG RAM Locate clearly and distinctly alII 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.! S II /.Jl1 I _..~.- --_. I, I... ' OJ ~3SI ~O' ,~,~ , ~ I~ 1...( I ~ ~ , f <I ~ L .300 - :> W '1<1' 1 , &.00 I our€' 01.$' ----- STATE OF NEW...YORK, /J :S.S IV, COUNTY OF . .:.U ~ . .~. . .. , . . . . . .1J/....#3'kl?-.r. . . q-;. .1<1< I,tRs. /<;./. . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant I (Name of individual signing contract) , , above named. i I He is the . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ar have performed the said work and to make and file this application; that all statements cont*ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne:r set forth in the application filed therewith. i Sworn to before me this ! "~Qjf~~J,,,'~""'19J:.O NWrnU~~....................~.... County /7~/ -1 i- N LINDA F. KDWAlsr<r' . ..~.I./G .......... OTAr1Y PUBLIC, State of New YorK No, 52'4524771 Q.uullfrcd In Suffolk County : CommissiOn- ExpJJe$ March 30, 1~8&