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Home My WebLink About16520-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16295 Date October 16, 1987 THIS CERTIFIES that the building DECK ADDITION Location of Property . .6. 9. .0..S.l:..e .e.p.y.. ~.o.I.~.o.¥..L.a.n..e ...... ?.o.u.t..h ?.l ff. ,...N.e?., .Y.o.r.k. ....... House No. Street Ham/et County Tax Map No. 1000 Section 078 .Block 0 I .... Lot l 0.9 Subdivision..~./.o..S.l. qe.p.y..H.o.l.l.o.w. ............ Filed Map No. 6351 ...Lot No. 7 conforms substantially to the Application for Building Permit heretofore filed in this office dated October 7, 1987 16520 Z ...................... pursuant to which Btfilding Permit No ...................... dated 0 c t o b e r 1 1, 1987 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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to RAYMOND & CECELIA KRUPSKI ..................... ?oYn'o;,:t g4r glf, ] x x ................... of the aforesaid building. Suffolk County Department of Health Approval ...... N / A UNDERWRITERS CERTIFICATE NO.. N/A PLUMBERS CERTIFICATION DATED: N/A Buddmg Inspector Rev. 1/81 TOV/N 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) Ne 16520 z Permission is hereby grantee[to: ~ .......... ,~..~.., ................ ~,~-, ~ ........... ~ . ~"~"~'~'""~'"~~:'~ ........ ~ ............. ~::~-'"'~":';"~ ............. i ........ at premises located at ..G,C~.(~...~.~...~,.~....~ .................... County Tax Map No. 1000 Section ..... .(~..1....~.. ........ Block ...... ..~....I ......... Lot No...[.:.?...~..~. ........ pursuant to application dated .... .(~.~....~,....'1 ...................... , 19.~...~.., and approved by the Building Inspector. Fee $.~...:...'~ .... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 BLDU ' 'OLD APPLICATION FOR CERTIFICATE OF OCCUPANCY. Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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 natural or topographic features. 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: Additions $25.00 I. Certificate of occupancy New Dwelling, $25.00, Accessory IS10-00 Business $50.00 2. Certificate of'occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewConstruc%ion ...... O~d or Pre-existing Building ............ Vacant Land ............. Location of Property . /,~O.. ,~O~Z ¥l!~.\.~g,'o.~,,.Ot .~... % Qg..'~..O.~ ..... House No. Street Hamlet Owner or Owners of Property .t(O~.~%~.i-L(~.L~\Ln~..¥~F:~)~Y~\ ............................. County Tax Map No. lO00 Section ..... (~."~.. ~ ..... Block ..... ~ .......... Lot .... .~. .......... Subdivision ................................. Filed Map No ........... Lot No .............. ~,¢~0 of ~0. ~. x. ~..~¥?Appli Permit No ........ Date Permit .. cant .................................. Health Dept. 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 and regulations. Rev. 10-10-78 765-t1102 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] I~SULATION []FRAMING [~FINAL REMARKS: ~~~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL,: 765-1802 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAIL TO: Approved .~..e~..~,~e~ .\\ .... 19'~..Permit No.\?,.~ .aP..~... lo ~5r7 Q/C' Disapproved a/c ..................................... (Building Inspector). APPLICATION FOR BUILDING PERMIT Date..~.~. INSTRUCTIONS a. This application must be completely fiiled 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 fofany 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 admitauthorizedinspectorsonpremisesandinbui!dingforn~essaryin~ti6ns.)~~ .pt? ~/~g?~' (Signatfire of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .4(..r4'.. ............................................................................... Name of owner of premises . ~.~. ~...~.~ .g/~... ~....~.~.~.~.Z. ri4t...../.~..tff.~...~..~.-~( ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) - ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... /~ Zo/4 Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done] ................................................. .f.q ........ .... ......... r.q z.rr.7../ ..... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~..'7.~> ........ Block ...0../. ............ Lot...~..O./...O..O..~. ..... Subdivision .... ?..~.4.~..~....~ .~..~5..o'.~ ............. 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 ...... ~ ...... ~....t~.~..~. , .O..~..~...~.~..~../.~.~.. g).O.J~'Z£/.~..~ .... b. Intended use and occupancy ...... .fl..g4.7{..~.~. C/,4//z ~4~,4~gr~ dq/~Z~r'/ffg' 3. Nature of work (check which applicable): New Building ' Addition .~.~..[ ~..E.6,/'( Alteration .......... Repal Re 1 D lido ' Othe W k r .............. mova ..... 0 ........ cmo n ........... · r or ............... (Description) 4 Estimated Cost ~./, ~ tro Fee " (tq be pald on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelhng umts 9n each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type !of use ..................... 7. Dimensions of existing structures, if any: Front . 3~ .~ ' Rear . $¢./. '. Depth Height .... ~t/.r ....... Number of Stories . ./~.. [.'~. ..................... .......................... Dimensions of same structure with alterations or additions: Front ...f.6./ ........ :... Rear jy 6 t . Depth ..... P. ~ ! ............. Height ... ~. 4(.' ............... Number of Siories ...... 2... o. ......... -8. Dimensions of entire new construction: Front .... /..~. :'. Rear .l*.//. i Depth .l Height .... ~J.. l'.a.~.~.~. Number of Stories ...... ~ ...................... ~ .... 9. Sizeoflot: Front ...... /.~ .............. Rear .... (.t/.q.~. ........ ...... Depth )J.~. ~ ..... ~ 2)ff. ' ....... 10. Date of Purchase ........ ${.~{.?2. .............. Name of Former Owner ...~d~q..(.d.~.~.3.~?.K.(. ........ ! 1. Zone or use district in which premises are situated... ~.~.? ~ t.4'.I?.t~4-z- ! 2. Does proposed construction violate any zoning law, ordinance or regulation: . .~.q.. .......................... 13. Will lot be regraded ........... ~.o. .............. Will excess fill 1 premises: Yes No 14. Name of Owner of premises . .,q~.'(.~lt~4r.O..j;f~¢P. $'~. Address &¢~. ~ No...7..~. ~:..7.~.r.g.. Name of Architect ........................... Address Name of Contractor .......................... Address ~5. Is this property located within 300 feet of · If yes, Southold Town Trustees Permit Locate clearly and distinctly all buildings, whether existin ~roperty lines. Give street and block number or description accordin nterior or corner lot. 3TATE OF NEW YORK, S.S :o,u rY OF ................. dimensions from whether ·., ........................... being duly sworn, da, po~e~and says,tlla, t.he~$ (Name of individual signing contract) -. tb6ve named. (Contractor, agent, corporate officer, etc.) )f said owner or owners, ~d is duly authored to perfom or have perfo~ed the sai~ work and to m~e and file t~s tpplication; that all statements conta~ed ~ this application are ~true to the best of his knowledge and belief; and that the york will be perfomed in the m~ner set forth ~ the application filed therewith. iwom to before me this : ....... 4ot .e" ....... ::.::'.." ".. . County / / ,: ................... ~:), ~,~ed~ ~, ~ ~ ~ (Signature of applicant) ~: ~- No. 4707878 / .-.'" LOT ~5' . '" ;-IAF 01; '¢,/£51 Cr.,'EF, K 5UFR HEALTH SUFFOLK CO. HEALTH DEt'T. APPROVe' H.S. NO. ~-.."L.~ "-~ ST AT~MEN~T_O_E_ I_N_T_E_N~T THE WATER SUPPLY AND SEWAGE DISPC SYSTEMS FOR THIS RESIDENCE CONFORM TO THE STANDARDS OF SUFFOLK CO. DEPT. OF HEALTH SERVl (si APPLICANT SUFFOLK COUNTY SERVICES FOR CONSTRUCTION ONLY DATE: H. S. REF. NO.: APPROVED: DEPT. OF HEA APPROVAL SUFFOLK CO. TAX MAP DESIGNATION DIST. SECT BLOCK PC )WNERS ADDRESS: TEST HOLE STAMP SEAL