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HomeMy WebLinkAbout12838-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25788 Date: 06/23/98 THIS CERTIFIES that the building ADDITION Location of Property: 59475 MAIN ROAD/ROUTE 25 (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 56 Block 3 SOUTHOLD (HAPiLET) Lot 6 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 15, 1983 pursuant to which Building Permit No. 12838-Z dated JANUARY 16, 1984 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.. The certificate is issued to JOSEPH F. & MARILYN KRUKOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-652364 07/19/84 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ~ ~~i~spector FOIL~ NO. 9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12838 Z Permission is hereby granted ,../-/.~,(.,.~...../~.~..~. ~ ............................................. ,o ....... ~.~-~.~.z~.~.~...~. ~../~....~..~.~...,~..~..-Zz/.~.~ ................... / ...~.~.~.././..~ ................................................................... ~ .......................................................... etp,e~',e,l~atedat ..... ~.~.~./..Z~ ....... ~.....~ .......... ~.~.~Z/~.....~.: County Tax Map No. 1000 Section .... ~...~.~6 ......Block ...~.. .............. Lot No. pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. ....~~~. Building Inspector Rev. ~5/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2.~ A~fproperly completed application and a consent to inspect signed by the applicant. a Certificate of Occupancy is denied, the Building Inspector shall state the ~.easons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction... ~ ..... Old Or Pre-existing Building ................. Location of Property.~.~.~5.~. ....... ~.~../~..L~...~ ...... ~.QR~ ~.~. ....... House No. Street Hamlet Onwer or Owners of Property..~ .~=.~. ~.~.~.~ ~. /~..~.~.!.~.7/~. County Tax Map No I000, Section...~.g ....... Block ...... .~ ........ Lot..~ .................. Subdivision /~L..g~ l .~ Filed Map .... Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Realth Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $.'~.~.. .................... ................. Co 5?$ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ SS JOHN STREET, NEW YORK, NEW ~ORK 1OO3~ Date vuly l~ l~ THIS CERTIFIES THAT only the electrical equipment as described belo~ and introduc~ by the applicant na~d on the ab~ application number in the premises of in the followlng location; ~ Basement was exa,~ined on July 1~, 198~ [~ Ist FI. FIXTURE OUTLETS RECEPTACtE~ SWITCHES 34 17 DRYERS FURNACE MOTORS FIXTURES FLUORESCENT [] 2nd FI. ~Jq~,~ Section Block and found to be in compliance with the requlrernents of this Board. RANGES COOKING DECKS OVENS FUTURE APPLIANCE FEEDERS Lot EXHAUST FANS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-10a~. C~L';~-~ ~k~)r opener 1-O.F.u. ~.. S E C NO. OF CC COND, A W, G NO. OF HI-LEG A. W* G NO OF NEUTRALS A. W G PER ,e' OF CC COND, OF HI-LEG OF NEUTRAL 1 i 1 R v I 11~71 Lio#578 This certificate must not be altered in any manner; return to the office of the Board if inco/rect. Inspectors COPYiFOfl BUILDING DEPARTMENT. THIS ( may be identified b) credentials. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 OFFICE OF THE BU TOWN OF ~ O2 Joseph Krukowski 59475 Main Road Southold, N.Y. 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate o~ file. XX The checks are not on fileS75.00 (3 CO'S) No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT #12813-Z,12838-Z&18693-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 February 6, 1998 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD Mr. Joseph Krukowski Main Road Southold, New York 11971 FIFTH NOTICE To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 12838-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. ACCORDING TO THE CODE OF THE TOWN OF $OUTHOLD, IT IS UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE UNTIL A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD March 24, 1995 Mr. Joseph Krukowski Main Road Southold, NY 11971 **** FOURTH NOTICE **** To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed)** No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT % 12838-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. - ACCORDING TO THE CODE OF THE TOWN OF SOUTHOLD, IT IS UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE UNTIL A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED. VICTOR LESSARD PRINCIPAL BUILDING INSPECTOR (516) 765-1802 FAX (516) 765~1823 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, NewYork 11971 ADDRESS: s c. This Buildlng Permit has expired. You are no~ vioiatlon of the Town of Southold Zoning Code. Please contact our office, this matter ~ust be corrected. Yours truly, Victor G. Lessard Principal Inspector TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. i 1971 TEL. 765-tS02 This is to advise you that the job under building permit no. 12~.8,~, issued to J & M Krukowski on .!J~_6_/v~~ ....... ~for Addition is completed and a f,aal inspection ~--'~ 7 ~-aa not ( X )'been done. In order to complete this file, it is necessary that a Certificate of Occupancy 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 the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certlfieete of Occupancy. Please help ua to clear up ti]ia matter so that legal action does eot have to be taken. Thank you for yo,r pcompt attention. ~'~-Ver!- truly~~ _y°ur , Victor Lessard Executive Administrator VI,: ga r encl . INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD December 8, 1993 SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Mr. Joseph F. Krukowski 59475 Main Road Southold, NY 11971 To Whom This May, Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xxx The check is (cut~atc~/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ BP# 12838Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. ~g!EL© ~N~P~CTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ../Y/~/.~... ~ ............... . .~a~.~.~o,./~..~... PLEASE TAKE NOTICE that your application dated. ~ .... ~ ............ 19 Ho~se ~o. $t~et ~am et co..ty Ta~ ~.p ~o. ~000 S~tio~ .. ~ .... ~oc~ ... ~.~ ...... Lot . ~.~ ...... Subdivision ..... ~ ....... Filed Map No ....... ~ ........ Lot No. is returned ~erewith an~ dis~rowd on the followin~ ~ro~nds ~~ ~. .~ . .~/1~..z~z~. .,. ,, ............. ~ ......... / ......... RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 APPLICATION FOR BUILDING PERMIT Date ( Z-. { ~c 19 ~'~g INSTRUCTIONS a. This 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 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 aiterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu!ation~, and to admit auth°rized inspect°rs °n premises and in building f°r nece~~' .~.: ................. _~,(Signat~e Of applicant, or~ name, if a corporation) (Mailing address 9f app~licant) ,To 5'-- Ro,..2 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .~..O.,5 .e--. ~3. .....~. ,...'~....~...~..F( ~/.5{y3...~.rT..(./. ~"0.(A)..~. j~ ['. ....... (as on the tax roll or l~test deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~..~.i ~ .............. Plumber'sLicenseNo. ff~. ¢ .~. ~.. . .'~. . .~_t~COt'~ t'~/ ~/t2'/9'l ~[ t~ c~ Electrician's License No. ~.5-'..~.~..'U..~.~.'7..~..~..~..~. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... .s--. ................. .............. .... : ......... House Number Street Hamlet County Tax Map No. 1000 Section ..... .O.~..~9. ...... Block ...... .O..~ ........ Lot.. dO ~) 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 ~.OT../.~(-'~d/.~~5 ..... ' ........ : ........... ~'t~t t~J~t~J ............................. b. Intended use and occupa=y ....................... Nature of work (check which applicable): New Building .......... Addition ..... r. .... Alteration .......... P, epair .............. RemOval ... ~ .......... Demolition .............. Other Work ............... ~ i ~ .... ~--,~.~c2 (Description) Estimated Cost ..... ~...~'~°.. i:. · .~. · ................... Fee ~ .~.. ~.~ ........................ (to be paid on filing this application) If dwelling, number of dwelling~units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... If business, commercial or mixed occupahcy, specify nat~r~ and extent of each type of use ............ / ~, ....... Dimensions of existing structures, if any:i Front .... .'~'..~.: ......Rear ...?..4': ~. ...... Depth .. ~:.4~. ........ Height ............... Number of Stories ........ ..~. .........,.. ....................... ~%. .......... Dimensions of same tincture ~vith alterations or additions' F-,-t ~ , · . / Depth ................... ,.. Height ...................... Number of Stones ...................... Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height .............. ,. Numb~er of Stories ............ Size of lot: Front .. /22 5~ i ' A'..~. ~ ....................... " .................. pth ........ r ........... Rear ................. De ................. Date of Purchase .......... i ...... i ........... Name of Former Owner ............................ Zone Or use district in which pr~mises ar~ situated ......................... ;~7'~ ........................ Does proposed construction violate any ~oning law, ordinance or regulation: .... /.'..':' ....................... Will lot be regraded ....... .~. .................. Will excess fill be removed from premises: Yes ,N~o Name of Owner of premises ........ i~ .......... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No .............. Name of Contractor ......................... Address ................... Phone No .......... ..... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions property"lines. Give street and block interior or corner lot. from number Or description according to deed, and show street names and indicate whether STATE OF NEWYO,,RK,~ COUNT F :~"-- · · ..... ~Q~~~~ ..... being duly sworn, deposes and says tha~-~e is the applicant (Name of inflividual si~ning conffact) above named. ' (c ) ~ ontractor, agent, corporate officer, etc. of said owner or or)nets, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements conthined in ihis application are true to the best of 4~knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this ......... ',. ~..":':...day of.. ,~'~'~, 19 .".~.~ '' .............. , II ,4B,,Y If copper tubing is used for Water dislributing sys em; p~!:i,g shall be of types K or L only ~cE>/ bA TI/.;A( 'o . hZ A