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HomeMy WebLinkAbout22109-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF O~uwANCY No Z-23654 Date MAY 17, 1995 THIS CERTIFIES that the building Location of Property. 38030 MAIN ROAD House No. County Tax Map No. 1000 Section 85 Subdivision ADDITIONS CU'i~OGUE, NEW YORK Street Hamlet Block 3 Lot 8 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 18, 1994 pursuant to which Building Permit No. 22109-z dated J~NE 6, 1994 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 TWO SHED ADDITIONS TO EXISTING AGRIC~L','uRAL FArM STAND AS APPLIED FOR. The certificate is issued to ALBERT J. & HELEN A. KRUPSKI of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAU. $OUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....~..~.~. .............................................. 19..~....~... 22109 Z CounlvTax Map No. 1000 Section ......... 0~',,.~... ...... Block ......... ~ ........... Lot No ..... ~ ................... pursuant to application dated .........~./Z'/.. ~(~.. ................................. 19.,~....~... .... Building Inspector. Fee $........,,~:~. and approved bythe Rev. 6/30/80 TO[.I~ OF BOU'IIIOLD BU [I.D [tJG Ii E P;\I'.Tt IEHT TOUN Ils\L[. 765-1802 APPL]:C,\TION FOR CERTIIrfCA'['I~ OF OCCOPAt,'CY This application must be filled in by typewriter OB ink and submitted inspector with the following: for new building or new use: 1. Final ssrvey of property with accurate location of all bnildings, to the h. ilding 2. Final Approval from Hehlth 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 contail-s less than 2/10 of 1% lead. 5. Cormnercial buildisg, industrial building, multiple residences and similar buildings and installations,,a1 certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ail property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Ccrt:ificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - ~lew dwelling $25.00, Additions to dwelling $25.00, Alteratious to dwelling $25.00, Swinging pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00-, Commercial $15.00 New C~-r~-mz~cnzi-un ....... ~... Old Or Pre-existing Buihling... 21 ............ ocat on .............. .......... llouse No. Street tlamlet County Tax Map No 1000, Section ...... ~ ....... Block. ~ ...... Lot. Subdivision .................................... Filed blap ............ Lot ...................... .......................... ,,, ~ ~ ~ ;...,,. ,_ ./7 ~ ~ ~.e 7- ,..,. Permit re .~fi,/O~'~. .Date Of Permit ....,,. ............................. llealth Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ 'iequest for: Temporary Certificate ........... Fiual (:erticate ........... Vee Submi_t ted: ~.. ~%M. ~ ...................... ............... c Town Hall, 53095 Main Road P. O. Box 1179 Soulhold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 28, 1995 Mr. & Mrs. Albert Krupski 38030 Main Road Peconic, NY 11958 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 # 22109-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. rOUJDATION (1st) FOU~;DATIO~! 2. (2nd) ROUGH FRAME & PLUMBING INSULATIOH PER N. STATE ENERGY CODE FI;IAL ADDITIONAL COM~IE~;TS: Examined (~/..J" ............ 19'~/...~ Approved...~/.~ ......... l~:/fl/f'Permit No..~...~../..0. ? .~ Disapproved a/c ..................................... o APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1805~ BOARD OF HEALTH ......... 3 SETS OF PLA~S .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. 7:O71 FY; CALL ................... HAIL TO: Date .................. I INSTRUCTIONS Wa. Th/s 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 o£ lot and of buildings on premises, relationship to adjoining premises or public streets o~: 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 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. necessar~.~..~,... ~in'spectigns',/~-~ .... i ................ -- (Signature of applicant, or name, if a corporation) · .~.~. 4... d.e.o..x..v.../~.<..,../¥....,(~ .~ :.,,. :..~.. (Mailing address of applicant) State whether applicant is('6"~'~3 lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (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 ~icense No .......... x~. ............ Electrician s,License No .......... x~ ......... Other Trade s License No ............ xqx ........ 1. Location of land on which proposed work will be done .................................................. . $~..o._3. ~ ................. .~..~i .,--:....r'~.. ...................... P.e..,,:,..?. ,.' ..c ...................... . House Nu,n ber Street Hamlet Cotinty Tax Map No. lO00 Section .. ................. Block '-~ Lot ~ ' 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 ...~f' '5..~...'~. ?.~..~..~. .................................. b. lntendeduseandoccupancy ~'*xr~x .~-./.~..:...~. r~;ot~ '~,-/4 ,c.~t'~ J~ 3. Nature of work (check which applicable): New Building Addition..ULT..~.. ~-A~ieratiot{ .......... Repair ....... ;K,5( ....Removal .............. Demolition .............. Other W'o?E ............... a,.-~,,,,r~ ' t' (Description) 4. Estimated Cost "D-'r'-kS-'--~ ' Fee . ~...t ~.~.. --.*~.. ....... i .............. (to be paicLma~lin~ this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each'flbbr ................ · 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 ..... ~.g-. ...... Rear ....-3..z-r ........ Depth ...-~..~ ........ Height ............... Number of Stories ........ { ................................. Dimensions of same structure with alterations or additions: Front .... ~.~. .......... Rear . ..(Z'. '52'. ........" .......... ..... Depth .... ~. ~ .............. Height ......... ~ ............ Number of Stories .... /. ................. 8. D~menmons of entire new construction: Front ............... Rear ...g, ........... Depth .... /.oc. ........ Height ............... Nu.n}ber of Stories ........................................................ 9. Size of lot Front...I1~....5,.0..(~.,Tq.~.~_..~. Rear ...................... Depth ...................... 1 0. Date of Purchase .... j q.5..i? .................... Name of Former Owner ~ 'd'/.~. ..................... 1 1. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: . IV..O. ........................... 13. Will lot be regraded ... lg~. ..................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises {1./~.qw p.4 [~; ......... Address $~O~q..~..%~.g--g.~.qc.~.Phone No. ~..~.~. 7.~. ~.¥.~... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ...................... :'... Address ................... Phone No .............. '.. Is this property within 300 feet of a tidal wetland? *Yes ........ ~_J ........ *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate 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. 15. ;///77/ / ! STATE OF NEW YORK, coutcrY OF ...¥ .¢,.... S.S ..... ~ .[ ~.E..~...~....~.....f-:..~.~..~. \~\ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (Contractor, a~ent, corporate officer, etc.) 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 ....... ./...~.fT.~/~, -- - ~ ~,/f ~.'~,.,f. .......... day of.~ ./.~ ............. 19~.~ I~lotar'O~ublic. State of New ¥o,k ..... (~ .... : ''/~'~ .................. NO. 4961037 (Signature of applicant) Qualified in Suffolk C~ I1~ (~ommission E~pires ,.1~. i~,/9~ ~.