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Home My WebLink About15515-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15120 Date Nov.ember 24 ..................................... 19 86 THIS CERTIFIES that the building .... AJ~]z.e.r.~%;~.o. rt .................... 890 Bo~.sseau Avenue Sou]hold -- Locatmn of Property H~d~ ~]o ................... St/e~t .................. H~am/e~ County Tax Map No. 1000 Sect]on .... 9.55 .... Block , .0,6. ........ Lot .. 2.2. ........... Subdivision .................... Fried Map No ..... Lot No ........... conforms substantially to the Apphcahon for Building Permit heretofore filed in flus office dated .... ~qv,~.e]7. ~23-..., 19 86 pursuant to winch Bmldmg Permit No . 1. 5.5.1.5. Z ......... dated ,N. ov.e.r~.er. ,2.1. .......... 19 .8.6. ,was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for which this certfficate is issued is ...... The certfficate ]s issued to . .. ROBERT A, & JEAN L. KRAMKOWSKI of the aforesaid building Suffolk County Department of Health Approval ..... N./.A ........................ UNDERWRITERS CERTIFICATE NO ......... P.¢ .n.d..in. cj..11./.2. 9/.8.6. .......... Bufldtng Inspector Rev 1/81 IrOTM ~0. B TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT El'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJ~PLE~ION OF THE WORK AUTHORIZED) N~ 15515' Z Count,/ TOX Mop No 1000 Section .... ..~..~... ,. Block .......(~)..~. ....... Lot No ......~...,~. ....... ~.~.o.t to o~,co.o. ~o,~ .,.~ ~~..,,~.! ...... I~.~..G, on~ ~p~o~ed ~ the Building Inspector. Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s application must be filled in Wpewnter OR ink, and submitted -, amammmaa to the Building Inspec- tor with the following; for new buddings or new use' 1. Final survey of property with accurate location of all buildings, property hnes, 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 electrmal installation from Board of Fire Underwriters. 4. Commercml buildings, Industrml buddings, Multiple Remdences and similar buddings and installa- tions, a cert~fmate of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planning Board approval of completed s~te plan requirements where apphcable. For existing buddings (prior to Aprd 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 buddings or premmes, or other pertinent mforma- t~on required to prepare a certificate. C. Fees. 1. Cert]hcate of occupancy $5.00 2 Cerbf~cate of occupancy on pre-existing dwelhng 3. Copy of cert~hcate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Update~ C.O. $15.00 NewConstruc%lon~.. Old orPre-exmtmgBulldmg $15.00 Date ...................... ........ Vacant Land ............ Location of Property ...890. ~[ois,~aU. A,v.~, ............. ~.qu,~z.o.%(~ .................... House No Street Hamlet Owner or Owners of Property ..... ~ERT, J~, . & .J~, .~, , ~,pj~v~Q~..~;[ ................ County Tax Map No. 1000 Section .... 5.5 ......... Block .. 06. Lot 22 Subdlws~on ................ Filed Map No ........ Lot No .......... Permit No ........ Date of Permit ........ Applicant ............................... Health Dept. Approval .................. Labor Dept. Approval ........................ Underwriters Approval . .~'~P-.~.~.~.g ......... Planning Board Approval ..................... Request for Temporary Cert~fmate ..................... Final Cert;ficate ....................... Fee Submitted $ .......... Construction on above described building and permit meets all applicable codes and regulaUons Jean Kramkowski Applicant ...................................... Rev 10-10 78 OUNDATION (1st) OUNDATIOt~ ( 2nd ) OUGH FRAbIE & FLUMBING .o NSULATION PER N, Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO 1 " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y 11971 TEL.: 765-1B02 E×amined ~)~b~ Z~I, 19 ~¢ Approved ~~/ , 19~ b Pe~[t No ] ~%~.~' ~ Recezved ........... , 19. Disapproved a/c , (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ....... 19 INSTRUCTIONS a Tlus application must be completely filled In by typewriter or in ink and submitted to the Budding Inspector, w~ sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing locatmn of lot and of buildings on premises, relatmnshlp to adjoining premises or public str or areas, and giving a detmled description of layout of property must be drawn on the diagram which is part of tlus a! cation. c. The work covered by flus apphcatlon may not be commenced before issuance of Budding Permit d. Upon approval of this application, the Building Inspector will ~ssued a Braiding Permit to the applicant Such pe shall be kept on the premises available for inspectmn throughout the work e No budding shall be occupmd or used in whole or in part for any purpose whatever untl~'-a Certificate of Occup; shall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldlng Permit pursuant tc Bmlchng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmanc, Regulahous, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto descn The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulations, an admit authorized inspectors on premises and m budding for necessary inspections (Sl~i;~ture o,~ applicant, or nature, if a corporauon) · '' (rna~.~_±ng address of appl~.canl:) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrlcmn, plumber or buff Name of owner of premises ~Ob6F~../~ ? .~/~. /-x'.'.. K~./~.'~D60'~/~''C . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer 2 (Name and title of corporate officer) Builder's License No Plumber's hcense No Electrician's License No Other Trade's License No .. Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section 0~ Block Hamlet ... Lot. Subdivision .. Fried Map No .. . Lot (Name) State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction a ExisUnguseandoccupancy OAJt~ ~C"~,/Y)14-~r~ H~oJ~ r~t)-/e ,,~c.~&. ~..~' b Intended use and occupancy 3. Nature of work (check which applicable) New Budding . . Addition . . . Alteration Repmr ... Removal ........... Demohtlon .. . Other Work ........... (Description) 4. Estunated Cost ~'.5.,.oo.o. ................ Fee ............................ (to he paid on filing thxs application) 5. If dwelhng, number of dwelling umts . .~q~ .. Number of dwelling umts on each floor. ."7~. ......... If garage, number of cars .... IJ2341 ........................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ~t/~' ......... 7. Dimensions of existing structures, if any Front eg' z '"... Rear t a ~o .'T. ..... Depth 2.,~.~..~... Height 8' .. .. Number of Stones .. ~. Dmaenslons of same structure w~th alterations or additions Front ,~'tqODA~ .... Rear..~,~h~i ..... Depth ~ ..... He~t .. ~ .... Number of Stones .. ~ ..... 8. D~ens~ons of entire new construction Front ....... Rear ...... Depth .m ....... Height ~. .. Number of Stones~[. ~:~)~ ,:~] . ::~;: . 9 Slzeoflot Front. I~ ... Re ~e~ 10 Date of Purchase *-z~-q~ .......... Name of Fomer Owner q., ~*r~~ ............ 1 1 Zone or use district in which premises are s~tuated .... 12 Does proposed construction vmlate any zomng law, ordinance or regulation . ~. 13. ~mlot~}regrad? ' ~'~Q~d~oc g~go''~l}~xqe~lberem°ve~fr°mprem~ses' Yes 14. ~meoiownero~prem~seso ~ · ~:' .~ ~¢(~ PhoneNo~/6~ N~e of ~ch~tect ............. Address ............. Phone No .......... N~e of Contractor ................ Address .............. Phone No .......... 15. Is th~s property located w~th~nl00 feet of a t~dal watiand? ~ Ye* ..... No ~ If yes, 5outhold Tom Trustees Cermet may be required. PLOT DIAG~ Locate cleaxly and d~stinctly all buddings, whether ex~stmg or proposed, and, mdmate all set-back dn-nens~ons from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~£~ AT/-/] C~ ~'~) ~o,~tJ~ ~/ ,I STATE OF NEW YORK, S S COUNTY OF. (Name of individual signing contract) above named being duly sworn, deposes and says that he is the applicant ........ d t. daycr/° - 'qotary Public, . ....... NO 470 He is the ....................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and file tlus apphcatlon, that all statements contamed m th~s apphcation are true to the best of h~s knowledge and behef, and that the work wdl be performed m the manner set forth m the apphcat~on filed therewith. Sworn to before me th~s