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Home My WebLink About14508-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z15024 October 22, 8.6. No .................. Date ................................. 19. THIS CERTIFIES that the building One family dwelling with second fl?or · . balcony Location of Property/2/3~.?e..L.? .e.w.a.r.d...D.r.~..v} B ou g.hold . o. ' ...... 'S't /e ~ i ..................... h ~ /n iel County Tax Map No. 1000 Section . .0.7. 9. ....... Block .... 0. 7. .........Lot . .0.2.3. ............ M/o Leeward Acres 5599 34 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .N.o..v.e.m.b..e .r..2.7.: ....... 1 ~.5.. pursuant to which Building Permit No. 1 dated ....d.a.n.u.a..r.y..?.: ............ 19.8.6., 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 ......... .Q~.e..£ a..m.~.~.y...d.w.e.~. ~..~.n~ .w..~.~.h..s..e.c.o.n. 0...e.!o..or..~.a. ~..c9.n.y' ......................... The certificate is issued to John A. Krakowka & Michelle Krakowka (owner, t~s~o~:~R of the aforesaid building· Suffolk County Department of Health Approval 85-20- J 4fi UNDERWRITERS CERTIFICATE NO ................... h17.~.3. Q ~ .4 ....................... Plumbers CertiYication dated October 157 1986 Rev. 1/81 I~'ON,~ NO. ~ TOWN OF $O~TSOL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) ....... ~O.~:~.L-a,O.C ...... i....~:..M ....... LL.ct...'1~I ~0 ....... .~ .~..c,~ .'~..T. C4....~... c:E.......o..~.~...., i.--.--.~..~L.~..~..~........P...~,,Z..~-4~.~../. I~ .G,~. ...... ot premises located at ..... ~....(~.....~.-'~. ......... LJ~..~:.'~.~..,~'~..~-~.~.........~...~ ........................... ....................................................................................................... .~..a~..T.. L~ .o.L.,~...,../~,~..~ ...L~.u.z-~z.,).. ...... Ac.q_c--~........m...~..~ ................... ..L,. a~.. ........ ~ ......... County Tax Map No. 1000 Section .... .0...-~....~ ..... Block ..... .(~....~ .......Lot No....O..Z.~ ..... pursuont to application doted ...~...~...~. ............ ....~.-.~.~. .................. , J~nd opprov~ by the Building Inspector. Fee $...~, ;_ J...~-2 ...... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTNOLD Building Department Town Ha~l Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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: I. 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 buitdings, 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 iprior to April 1957), Non-conforming uses, or buildings and "pm-existing" land uses: 1. Accurate survey of property showing all property Hnes, 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 I~ousing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. 1. Certificate of occ_upancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 NewC°nstruction ..... %~,. Okl or Pre-existing Building ............ Va cantLand ............. Location of Property../~ .~>.: ........... ' ...... A ¢..~.~:¢:. g.. ~. :.:. ~ .......... ~ ¢~ House No. $tree~ H~mlet County Tax Map No. 1800 Section 79 ~ ~ ............... Block ............. Lot ................ Subdivision · 0~ ~.C¢~J... CF~.Fi~edMapNo.~-f.~ .... LotUo...~.¢ ....... Permit No. }.~ ¢~ ~-. Date of Permit .......... Applicant .... ~.~ .~ (~.~/.~.~ ........ Health Dept. Approval .................. Labor Dept. Approval ........................ Unde~riters Approval ~ 7 ~ ~ ~& ~ Planning Boer royal ..... ............. d App ................. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~. :~....~ ~... Construction on above described building and parapet meets all applicable codes and regulations. ....r/ ................... Applicant R~v, 10-10-78 R.c 3 o$'73 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTIIOLI), N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit Owner Plumber ~o. ~ ~ s-og L (please pr~nt~ (pleas~ pri~t) / Date I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this -- ~- _day of je~L~/~____~' 19~ · Notary Public, --~c4~-C°unty Commission Expires Mamh THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001165 BUREAU OF ELECTRICITY ~[ 85 JOHN STRBBT, NEW YORK. NEW YORK 10038 o~ly the electrical equipment ~ ~scribed below a~ int~uced by t~ applicant ~m~ on the a~ve application number in the premises of John Kr~kowk~, Loewood Dr., off Jacobs Lane, Southold, New York the following locat~on~ ~ Basement ~ Ist FI. ~ 2nd ~. Section Bilk Lot ~s exandned or, A~g~ ~ ~ 4 ~ 1 ~ 86 and found to be in contpliattce ~'ith the reqalrement s ~f this Board, FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS FIXTURE SWITCHES OUTLETS FLUO~ESCEHT 49 49 DRYERS MULTI-OUTLET SYSTEMS NO. DE FEET OTHER APPARATUS: I~C~, F, I. 2-Smoke Detectors E R V I C NO, OF CC COND A W~ G PER~. ~OF~~' OF CC, COND NO OF HI-LEG A. WG OF HI-LEO NO OF NEUTRALS 1 Howard Dil lingham Box S74 Laurel, N.Y., 11948 lic, ~756E OIENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incc~rrect Inspectors may be identified by their credentials. COPY FOR BL~ILDING DEPARTMENT. THIS COPY OF CERT F ~AT-E MUST:NOT BE~: ~.:!ALTERED IN ANY ~HNER. F!ELD~iNS?ECTiON _>ATE FOUNDATION -~ (1st) _ FOUNDATION ( 2nd ) ~ ,~ _ ,STATE ENERGY ADDITIONAL COMMENTS: 765-~802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [] ROUGH PLBG. FOUNDATION 2ND []INSULATION ,/~..,~*'~ FRAMING []FINAL DATE INSPECTOR 7G54802 BUILDINGI DEPT, INSPECTION []FOUNDATION IST [] ROUGH PLBG. []FOUNDATION 2ND []INSULATION []FRAMING []FINAL REMARKS= ~) ~ ~ t~ ~ DATE~t''') '" ' '/-'' 'INSPECTOR ¥/.C,~ 7GS-X802 BUILDING D£PT. INSPECTION [ ] FRAMING RE:MARKS: FOUNDATION 1ST [ ]ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FINAL DATE 765-1~0Z BUILDING 'DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG~ FOUNDATION ZND [/~ INSULATION ~,/~ INSPECTOR ~' DATE 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~ ROUGH PLBG. FOUNDATION ZND [ ] INSULATION DATE ~///?~/~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~ FRAMING []FINAL REMARKS: .~ ~ ,df DATE ~/~ INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~.~...k~l....[..~.. ,, 19 .~..¢ Approved 5f~ .i%-t.....% .~..., 1 .9~.. Permit No. 1.~....~. · .8~- Received ........... ,19... Disapproved a/c ........ ~ ....... j,s) ........... APPLICATION FOR BUILDING PERMIT Date..//.% ~..~ ......... 19 .~.5.~ 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. e. 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 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 building for necessary iny~ections. , __ .... ............ ~i~nature 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. .............. ¢..C ....................................................................... Name of owner of premises ...... ~.~ ~ & h 6. l .~....~......~.~..&. g.q .u4. ~( .~ ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer, (Name and title of corporate officer) Builder's License NO .... "~..... ......... Plumber's License No. ~ q ~ Electrician's License No .... q.D.~. ~. t~. ............ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map Ng. 1000 Section .... ?. ~ ........... Block ..... .~. ........... Lot ..... ~ .~. .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ..... D. ~,v;3...~3 .~.t~ ~ .... .C.o..D.5. ~L.v..ct.d~ .nL..9 .F/ ............................. 3. Nature (~f work (check which applicable): New Building .. ' ..... Addition ......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ................ . , (D ripti ) 4. Estimated Cost. j .D o O Fee .... '~ (to ble paid on filing this application) 5. If dwelling, number of dwelling units ..... { ......... Number of al{veiling ufiits on each floor ................ If garage, number of cars ....... ~'~ ................................ :.. ......... ... ................ 6. If business, commercial or mixed occupancy, specify nature and extent of each t~,pe of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ...... , ........ Depth ............... Height Number of Stories Dimen¢ions of same structure with alterations or additions: Front " ' Rear Depth ' Height Number df Stories 8. Dimensions of entire new construction: Front .. ~ / / Rear $ ./ ' Depth .~..~,.. ?.. Height ..... .~ ......... Number of Stories ..... ~ .................... i ............ ~' ............... 9. Sizeoflot Front .f.Y..*?.~. . Rear ....~.~.r./. 10. DateofPurchase ~' ~.~. Y~' Name of Former Ow er 7Faze h La '~o~ ........................ n , .....? ....... ~(q ......... 11 Zone or use district in which premises are situated ' 12. Does proposed construction violate any zoning law, ordinance or regulation: ...I .... ' .................. 13. Will lot be regraded ........ , .................... Will excess fill be removed from premises: ' ' ' ~ N~ 14. Name of Owner of pre,,mises ~,.c.h.e. ll¢..~ f.a.~.o~/.<,& Address 1~.o~.~? 7.7.. ~.qOp~.oJc, l.. Phone No..7¢~? ! .q{.... Name of Architect ff.e~.~r~/ ~,u, vlqhe.r..f,,.o... .Address ..gree~9£or~,hl,.~/ PhoneNo Name of Contractor .~..h..~. ~r. Ot.<.o~./iq_ .......... Address ~.3p.,v. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, ifidieate 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. '(Re~) (,~,~ c~ ) , , / '-5; :: / o o o ,/ £LOCK / C~OUNTY OF ................. ...... sworn, depo es and says that he is the applicant (Name of individual signing contract) : auuve nameS. ' He is the .: (Contractor, agent, corporate officer, etc.)i i of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his :knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this " ........... ....... day of. ........... , / ,"4"7 RODERICK VAN TM'EL UCENSED LAND SURVEYORS GREENPORT NEW YORK N61239 SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (st APPLICANT SUFFOLK COUNTY SERVICES -- FOF CONSTRUCT ION ON DATE: H. S, REF. NO,.~ APPROVED: DEPT. OF HEALTH APPROVAL OF Sb"FFOLK CO, TAX MAP DIST. SECT. BLOCK OWNERS ADDRESS: TEST HOLE STAMP SEAL SUFFOLK CO. HEALTH DEPT. APPROVAL ~ ,Y ~, a ~ THE WATER ~LY AND SEWA~ DIS~SAL .z.:~ ~=,~L.~,~ CONFORM TO THE STANDAR~ OF TH~ I ql If~'OLK COUNTY DEPT OF HEALTH S~LK~COUN~ HEALTH DEPA~MENT . sE~ VICES -- FOR APPROVAL OF ~N ~ 8 N~ FAMILY DWELLING ONLY S~ IFFOLK CO. TAX MAP THE SEWAGE E SPOSAL AND WA~J~R SUPPLY FACILITIE3 Fi )R FHt~I ST. SECT.~K' , ~.g., LOCATION HA~ E BEEN INSPEC] :D BY THiS DEPARTMEI IT AND[~ ~ Chie~ ~f Wa~tewater Management Section ~i~"~Xe:~ RO~ER(CK VAN TUYL:'~.'~7 ........ GREENPORT NEW YORK ~pper tubing for water distributing ,'¢~ em; pipingshall be ~ol: types K or t · .LEFT $ t -r,D EE 765-1802 9 AM TO 4¢M FOR ~LLOWING INSPECTIONS: 1. FOUNDATION - ~O REQUI~E FOR POURED CONCRETE ROUGH - F~MING & pLUMBING 3. INSULATION 4, FINAL - CONSTRUCTION ~UST BE COMPL~E FOR C.O. ALL CONSTRUCTION SHALE MEET THE REQUI,REMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES.. NOT RESPONSIBkE FOR DESIGN OR CoNSTRUCTiON ERRORS. . Phca~e 47%0400. Main Road CR-EE, POlar: N ¥, ] 1944 ' ,I O~' ct! '~ F'O]:4',; H ,i ?',J f o \ :l Phone 477-0400 ~ Mai, Road GREENPOR F, N Y. 11944 , ~, ~ /,.,,: ¸'1 ',; y Main Roa~J