HomeMy WebLinkAbout13149-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificnte Of Occupnncy
No. Z-I5667 Date April 21, .1987
THIS CERTIFIES that the building . .A.D.r..5 .c.u. 1. ~..u.r.a. 1.. ?.o.Z.e...b.u.i.~ .d .~.a.g. ...............
Location of Property ...2.5.5.0...S.k.u.~.~.k. Lane Cutchogue, N.Y.
Houso No. ' .............. 'S't;~i .......................
County Tax Map No. 1000 Section 097 .Block 08 ...... Lot 31
Subdivision ............................... Filed Map No ......... Lot No
conforms substantially to the Application for Building Permit heretofore filed in this office dated
i~. a. y...2.2. ,...1.9.8fi. ........ pursuant to which Building Permit No. 13149Z
May 25, 1984
dated ............................ 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 .........
AGRICULTURAL POLE BUILDING AS APPLIED FOR
The certificate is issued to ALBERT J. KRUPSKI, JR.
..................... [o¥,,'o), '~¥ ~r~j~ X ....................
of the aforesaid building.
Suffolk County Department of Health Approval ... N/A
UNDERWRITERS CERTIFICATE NO. N/A -
N/A
PLUFiBER$ CERTIFICATION DATED:
........
Building Inspector
Rev. 1/81
FOuM bO. ~
TOWN OF .Sou'rHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13149 Z
Permission is hereby granted to:
..~.~....~.....~..~.....~.,. ....
~~.....~..:.~..: ...............................
,o...~..~....~..~.~..2~.....~..~.~ -'-- "-'-- ~'-'~ ....... ~ ................
r) ~ ~),~'.~-' ~ -- ' ~. ~ .....
County Tax Map No. 1000 Section .....C~.~...~. ......... Block ....... .~.....~. ........ Lot No ..... ..~..]. .............
pursuant to application dated ........... ...~..~......)=...~:.. ................ , 19.~..~.., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTNOLD
Building Department
Town Hell
$outhold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCt
Instructions
This application must bo filled in typewriter OR ink, and submitted ~a ~ 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 d{sposal-{S-9 form or equal).
3. Approval of etectr}cal installation from Board of Fire UndepNriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Arch{tact or Engineer responsible for the building·
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957)0 Non*conforming uses, or buildings and "pro-existing"
land uses;
1. Accurate survey of pzoperty 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 informs-
tlon required to prepare a certificate.
C. Fees:
l. Certificate of occupancy New Dwellin~.$25.00. 'Acce.~.sory :$10.00 Buslnes:l $50.00
2. Certificate 0-f occupancy on pre-existing dwelling $ 5 0.0 0
3. Copy of certificate of occupancy $ 5.'00, over 5 years $10,00
4.Vacant Land c.g. $ 20.00
~... ~./..~. ?....
5.U~dated C..O. $ 50.00 Date .........
6. ~lteratlon $25.00
NewCon~ bruc t, ion ' .~". Old or Pre-existing Building Vacant Land .
Location of Property ...........................
House No. Street Hamle~
Owner or Owne ......... . ...... ........ ... ................
3
County Ta,~ Ma, No. ,OOO Section ...9.. ~ ........ B,ock ..... 0.. ~ ...... ~.o, .... t .....
· ' ' Filed Map No Lot No
Subd~vts~on ..........................................................
Permit No...... . .. cant ..................................
Heelth Dopt. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval Planning Board Approval ....
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes ag,d
regulations.
Applicant .....................
Ilev, 10,10 7a
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted I~..,~,--- 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 unusual
nam ral or topographic featu res.
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 installa-
tions, 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 p~operty 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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00 .~.//~.~/./.~./..~.
5.Updated C.O. $15.00 Date ...................
New Building ....v~,. ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .~-..~..¢~.. ...............
House No. Street Ham/et
Owner or Owners of Property . ~. [ .~..~.%?...~..,.. ~.~'..c..~. ~..~..~.i..~....¢~-.. .....................
County Tax Map No. 1000 Section ...(?.?. ~. ...... Block .. ,~...~.. ........ Lot .... .~.../ ........
Subdivision ................................. Filed Map'No ........... Lot No ..............
Permit No. ~, .~..1..~/.~.. Date of Permit .~'"~ .~./.cF?.Applicant .~./.~>¢,~f..)~//,77¢.~..~. :'., .~.. ~ .....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ....... . .;,>~<'. .......
Request for Temporary Certificate ....... ~: .... Fna Cert ficate .. ~ ..............
Fee Submitted $...J.~'...~, ~. .................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ¢~;2.~, ./~ .Z~.'.,~,, .....................
Rev. 10-10-78
FOUIID ~ T I 071 ( ?nd )
FRAME &
PLUI'{BING
3.
ltlSU[,ATION PER N.
,STATE EI~EEGY
C,ODE
ADDITIO~IAL COMMENTS: ............. -~_-~_-~_-~==: =
7GS-'1802
BUILDING DEPT.
INSPECTION
[ ] FRAMING
REMARKS:
[ ] FOUNDATION 1ST []ROUGH PLBG.
[ ] FOUNDATION 2ND [1INSULATION
[]FINAL
June 1, 1984
Southold Town ~uilding Department
Main Road
Southold, ~Y l197t
The 'trusses were designed and con-
structed after viewing trusses in
other build].ngs, notably the Shamrock
Tree bu]ldin~ on the strip-zoned
Route 25 [n Mattitucko
I fe~l they w~ll adequately support
the alumi.num roof an~ the 30 foot
Rory Kl~.nge
'FORM'NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL,: 765-1802
Approved '~. ,~.., 19~.~. Permit No. J..~./.q. c~ .%.
~)isapproved a/c .....................................
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled'in by typewriter or in ink and submitted to the Building Inspector, with 3
ets 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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 Per, nit to the applicant. Such permit
hall 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
hall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department tbr the issuance of a Building Permit pursuant to the
luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
',egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on pre~nises and in building for necessary inspections.
. ................
(Signatu~ of applicant, or name, if a corporation)
(Mailing address of applicant)
gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
qame of' owner of premises ................. :'... .t ........................
(a~on the tax roll or latest deed)
if applicant is a corporation, signature of duly authorized of~%e-rl
(Name and title of corporate officer)
Builder's License No ..... -~.'..~. ! .~. ..............
Plumber's Licenle No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done. ~ . . -.~. ~ ~,'.~...~..[.°?.~)..~r'. .... · .~...~ . .~.
House Number Street Hamlet
County Tax Map No. 1000 Section ~? ~ Block O~ Lot.
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .....................................................................
· Intended use and occupancy ..... Y ................................................
3. Nature of work (check which applicable): New Building ........ Addition .......... Alteration ..........
Repair Removal Demolition Other Work
~ (Description)
4 Estimated Cost t/~ts/~ ;,-o Fee
~" (to be paid on filing this application)
5. If dwelling, number of dwelling units ............. Number of dwelling units oil each floor ...............
If garage number of cars
6. If business, commercial or mixed occupancy specify nature and extent of each type of use . .~-a.r. ~,...S..~.o ¢-.a~...
..... if any: Front Rear Depth
7. Dunenslons of existing structures ............................................
Iteight ............... Number of Stories ...................... , ................................
Dimensions of same structure .... Front Rear
w,th alterations or additions: ..................................
Dei~th ................... i... Height .......... . ........... Number of Stories ............ > ........
8. Dimensions of entire new consfmction: Front .... .3.0.'. ....... Rear . 3 ........... Depth . .~.,~. ....
Height /.S. ~ Number of Stories
9. Size of lot: Front ...... , ............ Rear ...................... Depth ......................
10. Oate of Purchase '~.l~...!. - - . . Name of Former Owner .~.,~,a~ C..09..~¢q.~.
11. Zone or use district in which premises are situated./~.,-.r.q~v!'}wr.~.l ......................................
12. Does proposed construction vidlate any zoning law, ordinance or regulation: ................................
14. Name of Owner of premises /~i!. Kc.-' p.~.~.;...-...W.c... Address ................... Phone No ...........
Name of Architect ......... i .................. Address ................... Phone No ................
iNa,ne of Contractor ........ ~ .................. Address ................... Phone No ..............
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
~roperty lines. Give street and-blo¢l~ number or description according to deed, and show street names and indicate whether
nterior or corner lot.
TATE OF NEW YOI~K, i S.S
'OUNTY OF .................
.......... : .......... being duly sworn, deposes and says that he is the applicant
u, rame of individua signing contract)
Cove named. .~.
{e is the ..................... ! ...................................................................
i (Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
pplication; that all statements con(ained in this application are true to the best of his knowledge and belief; and that the
~ork will be performed in the mann?r set forth in the application filed therewith.
',worn to before me this
L
0 ............. O-
f