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HomeMy WebLinkAbout19799-z r. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20206 Date SEPTEMBER 11, 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 200 GRISSOM LANE SOIITHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 78 Block 1 Lot 10.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit...heretofore filed in this office dated APRIL 19, 1491 pursuant to which Building Permit No. 19799-Z dated APRIL 23 1991 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 ACCESSORY INGROUND SWIMMING POOL & FENCE IN REAR YARD The certificate is issued to RAYMOND & CECELL?1 KRUPSKI (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-199376 - AUGUST 9 1991 PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 sows xo. s 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) N°- 1 9 7 9 9 Z Date .......~~......a ~ 19.41.. Permission is hereby granted to: - • D ..~.2.l.... ~.s'...A of premises I«ated at . aY..`~ ~fs.....`~1...~.: ~ . County Tox Map No. 1000 Section..... o.~..~...... BI«k Lot No...~.~ pursuant to application doted ..~.d.4.A~'.'S~......i!...1 19.9.., and approved by the Building Inspector. U Fee S..! sa.... Bu Iding Inspector Rev. 6/30/80 ~(~~~i?_,...,`~..,..„.~,pr,,,f Form No. 6 7W 9 L~0 TOWN OF SOUTHOLD BUILDING DEPARTMENT SEP 101991 t ~ ~ TOWN HALL 765-1802 F1LDCi. Cs E1>i'~ m TCIWfU (3~~ "~{1SJ~"I-COI C~ w„ pLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 1~ 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 properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..q`,\l'~~~1 New Construction........... Old Or Pre-existing Building Location of Property.~~.....~~C~~SJ rn.~~ .................c`-.'.~.v~~~............... House N'po., Street Hamlet Onwer or Owners of Property..~S~kS~{~?.'~..~`~C~`Q-~ ~~U(~,~~~,,,,,,,,,,,,,,,EE,,,,,,,,,,,,,, County Tax Map No 1000, Section...~~ ~i....B1OCk... ~.~.........Lot...~.~.a.J Subdivision ....................................Filed Map............Lot...................... Permit No..~~~..k!..L-:.Date Of Permit..A.ii.g:~~.?,.?~~Applicant...S~~:~:~.~\~.SQ~~S........ health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Gerticate........... Fee Submitted: $ C ~ '`z ~ o a APPLZCn R `x THE NEW YORK BOARD OF FIRE UNDERWRITERS ' E 10?.5023 BUREAU OF ELECTRICITY ~ 88 JOHN 3TREET. NEW YORK. NEW YORK 10038 AUGUST p9,1991 73555891/9] N 19937h Date Application No. on file THIS CERTIFIES THAT only tfu al/ctrbal /yuipasarit r dmribed 6doso and introdtscsd by the oppflasnt noosed on the /bone application numher in the prensisee of KRUPSRI, 200 GRISSOM 6ANE, SOUTHOLD, N.Y. - OUT a: in thefelbrsinR bastion; ? Bremen[ ? lot Fl. ? Pnd Fl. .Section Blaek Lot = soaa examined un JU1rY 25 ,199.1 and found to 6e in comp/lance with the reyuirementa of this Board. IIKTIIRE RX7UMf RA COOKRI6 RECK5 OVNK ffIEK WANINS EIWAUST f_AN_S_r OaT1ETS AC1K f NCMrtC[M NUORtaQM OTHER AMT. K. W. AMT. K. W. MIT. K.W. AMi. K. W. AMT. M. P. ~YLRS RlR/Uq MOTORS NTIIR! AttelAtlQ RWEIIS SM011ltlC?T TMIE CIOCllS Rpt UIMTNYTNf MINtI-0tlT1ET fIMAMRRS AMT. K. W. Oll K E OAS N. P. AMT. NO. A. W. G. AMT. AAV. AMi. AMTS. TRANS. AMT. - N. I. SYSTr15 AMT. WAIIa NO.OF q!T flRVK7 OIRCORNIRCT NO.Of 5 E R V 1 C E c..:, AMT. AAV. TPPE I / 7W I / 7W a ! JW 7 R aw NO. of CG COND. A. W. NO. OF HbIEG A. W. G. NG. OF mUTRAlS A. W. G. PER / OP CC. C OP lN~IEG Of NEUTIIAt - c _ --~a OTNH AMARATaS: ~ - Q ~ - f ei - f ...J Ptl ~ v, U NANK'5 RI,FCTRIC LI('.~25T5-E 121 SHEEP PASTURE RD S£TAUKET, NY, 9.17.33 oRNRAt MtWA9RR !i ~ ~ d,, Per This artfficate nef M ollered in arty monrr; rstwn to [Flt offiu of the Roord if inrmrretl. Inspsdors may ba identified. by [Mir tndentiak. ~ _ 0~1'I Wp.OM16 CtMlt"[IiiBFf`. ~IK fJirlf tlll ~R"~h!'MC~'TE IIMN'1~l19? 1E A1TlR~ IN A1F~ M11AM~1t. . THE NEW YORK BOARD OF FIRE WNDERWRITERS ~Ahr, ' a 1015(1?.3 6UREAU OF ELEGTRICI'TY V= 83 JOHN STREET, NEW YORK, NEW YORK 10038 _ A11G1PST 09,1991 ApplicotionNo.onfile 735h5891J93 F I'7v976 THIS CERTIFIES THAT only the electrical eyuiParent v dercribed 6slom and introduced 6y the appflcant rwmed on [he e6ore appNcotion numkerin the premiser of KRUPSKI, X00 GRISSOnnM LANE, SOll'CHOI,II, N.V. in the oUowin beation; /0 Basement ll(1`I' f R JtJLY :IO i 199 L ? ("t FL ? Ynd Fl. Sertiun Block Lot war examined on and found w 6e in compliencr with the reyuirementx of thin Boord. C R AfJRf Nt1TOIK RXTIARS RANOlS 0001t1N6 RECKS OVlPK DISX WAfi1M1!!i EXNAUST FAN4 tt2- NCANOESCEM PIUORE]CEM OTHER AMT. K.W. AMi. K.W. AMT. K.W. AMi. K.W. NAT. M. P. p I 1 1 i v- 1 oRYles RItltACR AgroRS PurwR APPUANC! etROws SMdAI REC?t TrAR cwclts tuu uttrc t1EATRRS t*An.ouriet DIIAMERS AMT. - K. W, dl n P. OAS N. P. AMT. NO. A. W. G. AMT. NN. AMT. NAPS. TRANS. AMT. N. t. ~ ~ T AMi. WAIT] i tj() RR- fRRVIC! 0!$OFIP/CT 1tO.OP 5 E R V 1 C E AMT. AAV. TnR ~ 1 / tW 1 / TN ] / ]M' ] / QV NO. d CC COND. A. W. 6. NO, d N4lEG A. W. G. NG. d NEUIIIALS A. W. G. - PER / d C .COND. d NIdfO OF NEUTRAL R! i OTHER APPARATUS: SKIMMING POOL-1 SPEC.IRL RSCRPT.20RMY./G.F.C.1.-1-2 C,.P.C.L:-1 *(SKIMMING POOL) Ibis certificate covers ct>tRpliance at the date of. Ev :inspection only. Aeeause of unusual ettvi.ronments it is advisable to have frequent test and/or repairs ° made by a qual.i fi.ed person. ~r~ c <t< Cont,inued nn Page 3 tl/IIQAt MANASEII jC' Per ! \1.t 1 This arfdicaro must riot be alNrad in airy Ilwnnsr; Mum ro tM offin of 1M 9oord if incorrect. InspPCrors may bs idsnNfiad by their crodmtiols.+ . CCMIY Ft3R t9UILDING DEPARTMBiT. THIS i'90fP OF C.~tFN<k1aM7E NNJ6T NOT E! ALTIRED IN i~N1f NIAIiiEtt. r1c:LD i1:SP~C;ION ~~lln:E ~ i;OMMLNT~ H ..p ~ FOUNDATION ( 1st ) o~ . _ FOUNDATION (2nd) - - 2. z o ROUGH FRAME & PLUMBING a y 3. ~ ~ m ca IidSULATION PER N. Y. ~ • • STATE ENERGY CODE x a r 4. y( ' _ FI;JAL . o . z ADDITIOPJAL COMMENTS: x - x .ti , H 9 ' H H O z . x m . A r . H ~ , r; • ~ .:x M ro th..s.u.1R.:.a'4.+. u~.- a, ~.,Si , r:....~L.m ii r Jr.' .t a.:., ...rkJw„~, A;w,.s..,u..sva».»~iA3d `ax~2b`.mw„''L 'Y'C, . Xa j4`,•, sc- a,.., ~~a~k~' u~~k ..x- .~v ..i`§ l 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ]ROUGH PLBG. [)FOUNDATION 2ND [ ] INSU TION [ ]FRAMING INAL REMARKS: DATE INSPECTOR - ~ BOAKD OF HEALTH 3 SETS OF PLANS • • a ,r,,r~ rz ,~~i -.i ~FORMN0.1 SURVEY ~1, ~ f ,_..l~l.~ TOWN OFSOUTHOLD CHECK "r~i?',. BUILDING DEPARTMENT SEPTIC FORM rr4 i. ~pR ~ g I9g~ , TOWN HALL J.41,,;, ;OUTHOLD, N.Y. 11971 NOTIFY t. CALL € TEL.: 765-1802 MAIL T0: d ,..:"r~... Examined . C'., 19 . Approved . ~9L. • 19q~.. Permit No.:~. / 7.7.4 .:Ca Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 19 . 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 ke,L~t can the premises available for inspection throughout the work. e. No burldii~p3sha11 be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have~e"~~ tld°by~ fhe`$uilding Inspector. APPLICA'$It~i~ISR;BBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant 'agree's to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized ihs'peetols on premises and in building for necessary insp ons. / (Signatu of applicant, or na e, if a corporation) § , (Mailing address of applicant) ytf /trl7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~Gl~/71.dQ.c~.ic..Y.7J~S~G1..o2CfQ..C?.-I.~IiSS4ryl..~:....Sd~~i9`~~ <J~/ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. (p Q. 9.~-z• Plumber's License No. , .N.~ hr7 . Electrician's License No. .....o~I:,,~l.~~t..~ Other Trade's License No. ...../U/r7........... 1. Location of land on which proposed work will be done: . . aad ...C~r~ss~rrt-,..ha.n:-eT..... ~.d ~.'fh.Ql.d, House Number Strepe~t Hamlet County Tax Map No. 100/0~Sec(t~ion ~ ~7 Block ~ Lot . ~ . Subdivision ~Qy}?. fl. T . ~J~'2? • •~Q~~OUJ Filed Map No. Lot 3......... . ~V/ (Na n~ 2. State existing use and occupancy of premises and intende/d use and occupancy, (oaf proposed /construct/ion: a. Existing u$e end occupancy I~e•S/. sl.-PILGrQ.:~"..... , vI!? ~-P ..V. H.!~?(!. b. Intended use and occupancy x~ f. ~ ....../."QCf/1. -......~~!?~.M!!1 ..GJ.QO~~'. • • • . • • . /p *i ture of work check which a plicable): New Building leration ` Rem • • Addition Alt . c3 Repair bval Demolition ........II ......Other Woik ~'Gt~!/.~1/.~?/rI. ~?d/ (Descrip2~) 4. Estimated Cost.......... ~'g~.a Fee...... ~ g I ` ' q g ~tis application) If arage, nwnber of cars ~ g be paid ~h•Ci~in t 5. If ~welling> number of dwellin units Number of dwellin units on each floors 6. If business, commercial or mixed occupancy, specify nature and extent of eac}} type of use . Hei ht Nur>}s tf an Front ...Rear ....L • • . • • . • •De h . 7. Dimgensions of existing structure~er of Stories pt . Dimensions'of same structure with alterations or additions: Front Rear . I, . De th........... 8. Dimenstons of entire new const 'Height , Numbe of Stories :Depth 'mrction: Front Rear . Hei ht Nu ber of Stories ~ p . Rear g ~ ...I........ ..Name of Former Own r . ]0. Date oflPur prase • , . ~ • . 1 Zone or use istrict in whic re p miser are situated De. t . 12. Does propose construction violate any zoning law, ordinance or regulation: . 13. Will lot be re raded ............................Will excess fill be reml'oved from premtse~: Yes No 14. Name of Owner of premises ................Address ..Phone No!; . Name of Architect ...................••••'''•Address .•....•..PloneNo~ Name of Contractor ~ . 15. Is this property located within 300 feet of a tidal wetlandl Yes No *If yes, Southold Town Trustees Permit may be re uired. ~ PLO"P DIAG}~AM Locate clearly and distinctly all'Ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ltumber or description according to deed, and how street names ~nd indicate whether interior or corner lot. I ENCLOSE P004 TO CQOIt UPON CCM~1{nl BEFORB . _ . UNDERWRITERS CERTIFICATE I, REQUIREDI, APPR VED AS NOTED y 1 DATE. ~~3~Q~ B.P# 9799 ^ UPAN~Y QR FEE: J ' ' ~ BY: 7 , u ' Le_.e.. rCCr N079FY Bt.IILDI,NG DEPARTMENT AT IMSE IS 765.1802 f3 AIVt TO 4 PM FOR 7HE FoI.LOWINC! IN~PEGTlofus: ~ TwOU~' C~,R71F'ICA3E 1. FouNDATIOf~ - TWa REQUIRED s ~ Oar OCCUPAN;OY FOR POURED CONCRETE I 2. ROUGH FRfAMING Z~ PLUMBING , . 3. INSULAT'!ON I 4. FINAL GONSTRUGTION MUST i BE COMP!-E'TE FOR CA t ALL CONSTRUCTION SHALL MEET s i THE REQUIREMENTS OF THE N.Y, - STATE CONSTRUCTION & ENERGY a GORES. NOT RESPONSIBLE FOR ' DESIGN OR CONSTRUCTION ERRORS STATE OF NEW Y R 5 S ' COUNTY OF ....~ul.,~:.... /2.~. ~a q ~CU sS bein dul sworn d ores and sa s tha (Nam~of individ/ual signir?g contract) . ~ ~ g y ~p y ~ he is the applicant above named. ~ He is the .......................:.....IL.. (Contractor, agent, corporate officer, et~cJ of said owner or owners, and is duly!, authorized to perform or have performed thg 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 het forth in the application filed therewith. Sworn to before me this I / Lf~.......day of .'',..l.~.l: < { 149. Notary Pu lic, , Count ~ ~ g~~/ Notary F ubbc, State of New York r Qusl fied~n Suffolk County .........Jr°v t~ • ~ . . nature of,applicant). 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