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Home My WebLink About16995-zFOP, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17823 Date MARCH 10~ 1989 THIS CERTIFIES that the building_ Location of Property 200 GRISSOM LANE House No. County Tax Map No. 1000 Section 078 ONE FAMILY DWELLING SOUTHOLD Street Block 0t Lot 10.5 Hamlet MAP OF Subdivision SLEEPY HOLLOW Filed Map No. 6351 Lot No. 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 29~ 1988 pursuant to which Building Permit No. 16995Z dated MAY 16, 1988 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & DECKS. The certificate is issued to RAYMOND & CECILIA KRUPSKI (owner, ~)L%~~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-so-51 FEB. 27, 1989 UNDERWRITERS CERTIFICATE NO. N055293 JAN. 26~ 1989 PLUMBERS CERTIFICATION DATED HENRY J. SMITH NOV. 22, 1988 Building Inspector Rev. 1/81 TO%VN 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) 6995 z Permission is hereby granted to: ..~ .~.....~.~....~..~.& ......~....~.&L~.~.~ ............................................... ....~.~.,L......~..,..V.,.,..zr..~.~. ........... ~,. ,o .~.~...,,....~...3~h.~.~.,..~...~..~.~~.~ ~...~.,....~...~.~.: .............. :..~,.r~?.....,.,......a..~..~,~.....~ at premises located at ...~..~. ...... ..~..~.~q~l~...~.~::~, ....... ~~ .................. County Tax Map No. I000 Section ...... ..~.,~..~. ....... Block ....... ..o...I ......... Lot No...,/..0...'..~.~. ........ pursuant to application dated ....~,~. ...... ~...~. ..................... , 19...~...~.., and approved by the Building Inspector, Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLO Building Department Town Hall Southold, N,Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted .- - __ 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 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ ]00.00 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 ..3.1.~./~.~ ............... NewCons truction ...... Old or Pre-existing Building ............ Vacant Land ........... .. Location of Property ~.~..~.... ~.[. t.~>.O...~-.'....¥~...~-_ ..... .~::.~L~.t-2..~.~ik~ Nou~ No. ' ................... ' .... O ner ' .......... County Tax Map No, 1000 Section ......... Block ............. Lot ..... ~). ........ Subdivision ..... .~'~.% .\.~P..~\~v~, ................ Filed Map No..~,'~..\...Lot No... ~ ......... Permit No. 1~.~..6 Date of Permit .6 1~ I.d.S. Applicant ~0'L~(~.'.~.C~.~,/,5-~..~U.~)5.~.t.. Hea~th 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~:eets a.II applicable codes and regulations. Applicant,~~_~..~-~.. ......................... Rev. 10-10-78 THE THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 26., ~ ',~/,,I'"~5 JOHN STREET. NEW YORK. NIEIACYOR,K,%~.: 29 P~'t.-[/~'I~ '10038 ~i (~'~ '~ :; /~pplication No, on file only the electrical equipment as described below and introduced by the applicant named on the obove application number in the premises of FIXTURE OUTLETS DRYERS FURNACE MOTORS Block Lot and found to be in compliance with the req~irements of tt s Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FUTURE APPLIANCE FEEDEES TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C E AWG. OF CC, COND A W G PER ~ OF CC COND. OOF NEUTRALS A, W O OF NEUTRAL h~':~;~f~; '~ '~ -, ~ be altered in an manner; return to the office of the Board if may be identified IILDING THIS COPY OF 'IFICATE I HENRY J, SMITH & SON, PLUMBING, HEATING & FUEL OIL MAIN ROAD SOUTHOLD. N.Y. 11971 (516) 755-3690 CERTIFICATION Building Permit Owner__R~j~R~__K~B$~j._ .............. Plumber__~j~ziZ_~_~lj%~__~_~ Inc. I certii'y that the solder system contains less than 2/10 used in the water supply of 1% lead. Sworn to before me this 22nd day of _~b_eK___, I988 Notary Public, ~2~2~ County FOUNDATION { 1st) FOUNDATION 2. ROUGH FRAME~'/ -FLUMBING (2nd) 3. INSULATION PER N. STATE ENERGY CODE FINAL ,, : ......... ~,~ITIONA'L COMMENTS: ~I.-~, , ~'~,~i ~>~' 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION AND FRAMING REMARKS: [ ] ROUGH PLBG. ]INSULATION [~AL DATE / / INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ I ~ISULATION FRAMING ~/] FINAL INSPECTOR 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ '*]'*~NSULATION [ ] FRAMING FINAL INSPECTOR U~, ~~ 765-1802 BUILDING DEPT. INSPE , ON FOUNDATION XST [, ] ROUGH PLBG. [ ~.OUNDATION 2ND ~/~ FRAMING INSULATION FINAL BUILDING' DEPT. INSPECTION [[~FoFOUNDATION XST [ ] ROUGH PLBG, UNDATION 2ND [ ] INSU'LATION REMARKS: FRAMING [ ] FINAL. ~ DATE INSPECTOR , 7,~ ]65-1802 BUILDING DEPT. INSPECTION [/~OUNDATION 1ST I~ ]ROUGH PLBG. FOUNDATION 2ND []INSULATION F~MING []FINAL FOI'~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~.O~ .1. ~o..., 198.5 Approved · .~.o~.! .~..., 19 .~.~. Permit No..).~o.~..~..~. Disapproved a/c ................................ "--/7 (Building Inspector) APPLICATION FOR BUILDING PERM IT SURVEY .......... CIlECK .......... SEPTIC FORM.~'/. ........... : NOTIFY .335.: ...... MAIL, TO: Date /~(t~e.~ /7 19~..~ INSTRUCTIONS a. Tiffs 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 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 h~ building for necessary insp~,~ions. · ..p.o... ..... T4.q.¢../(?.//27/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises /~y/)[rg/oJ) ; ~C~Z[~ ~&~' (as on the tax roll or latest deed) If applicant is a corporation, s[gaature of duly authorized officer. (Name and title of co~orate officer) . ALL CONTRACTOR'S HUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section O 7 ~ Block / Lot /~' ~ ........ Subdivision... 3'Z~E~P V /qoLZv ~ Filed Map No. ~ S ~ / .. Lot ~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupanoy ...................................................................... b. Intended use and occupancy ~/D ~'7/~ ~ WW z~,'//& 3. Nature of work (check which applicable): New Building 1/ Addition i · Alteration Repair ,: ............. Removal ........... Demolition ' Other Work ............... ' (Description) 4 Esrimated Cost ~'~, po ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... /. ........ Number of dwelling uni!s on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... 6,7/~. ............ ?. Dimensions of existing structures, if any: Front.../1<'/.~. ....... Rear ....... i ....... Depth ............... Height ............... Number of Stories ............................ ~ ............................ Dimensions'of same structure with alterations or additions: Front I Rear Depth ...................... Height ........ ,, ·: .......... Number oN Stories ...................... -8. Dimensions of entire new construction Front x~.(~ t : Pear 5-t~ t I Height ..... ~..~.t. ...... Number of Stories iii i. ~- ............... l ........................... 9. Size of lot: Front ....... t~.6/ .......... Rear ........ /qo.( ......... IDepth .... 10. Date of Purchase .......... II./Zqt//~.~.2 ........ Name of Former Owner ~ . (Mt .6.6.':~t.af ? .............. 1 1. Zone or use district in which premises are situated ....... .,~..r.t.0. ~.4r?.t.4-K...: ....................... : .... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... :. ~.q ....................... 13. Will lot be regraded ........ .cl~ ................ Will excess fill be removeld from premises: ~..~,) No 14. Name of Owner of premises .~ry. ,/~.~.-~.P. ,.fly~ ..... Address . ~.0.. t&..X . ,/.7 .ZIz.. , . Phone No.. ;F.~ .5~' .57¢/f... Name of Architect ... $aqTttrAqL.. IM,~. ~t.~. ~ ..... Address ...~.o,-.E~4 PO ..... i ....Phone No...2{ iv. 4-?.. ~T ~.. Name of Contractor .......................... Address .... : .......... i ....Plione No ................ 15. Is this property located within 300 feet of a tidal wetland? *Y~s ..... No' ..~r~... · If yes, Southold Town Trustees Permit maybe required. PLOT DIAGKAM Locate clearly and distinctly all buildings, whether existing or proposed, and, i~dicate all set-back dimensions from property lines. Give street and block number or description according to deed, and sho v street names and indicate whether interior or corner lot. STATE OF NEW YORK, : COUNTY OF ' S.S ......... ......... .... i .......... beingduly sworn, deeoscs and ~ays that he is the applicant (Name of individual signing contract) . above named. He is the ............................................................ : ............................. (Contractor, agent, corporate officer etcl.) , ~ &. of said owner or owners, and is duly authorized to perform or have performed the!said wo~ un'to make and file this application; that all statements contained in this application are true to the best of his ~nowledge and belief and that ~he work will be performed in the manner set forth in the application filed therewith Sworn to before me this .... ~. /~T~ .dayof. ////~t~CO~ 19 Ii*l" Notary Public, . ................................ County.......~.X.~.,fdS~.~'.~' (Signature of applicant) SUFFOLK CO, HEALTH DEPT.. H.S. NO. SERVICES -- FOR APPROVAL. CONSTRUCTK~N ONLY DATE: ,,~ , , H: S. REF. NO~: . , APPROVED: , , SUFFOLK ~:0. TAX Distr. SECT,. BLOCK SEAL b /.o/ 4- RO~ERICK VAN TUYL, P.C. LICENS~D LAHI:) SURVEYORS NEW YORK SUFFOLK CO, H~ALTN STATI~M~NT OF INTENT THE WATER SLIIq~.Y AND SEWAGE SYSTEMS FOR THIS R~I~CE C~FO~ TO T~ ~AN~R~ ~FF~K ~. ~. ~ HE~ ~ICANT SUFFOLK COUNTY SERVICES -- FOR CONSTRUCTION ONLY 081~1'. 0¢ APPROVAL H. S. REF. NO.:. APPROVED:. SUFFOLK CO. TAX M~P I~IIII~NATION: DIST. ~C!. ~I. OCK ~. ; /o00 07~ I ~' ,. OWNERS 5l~ek,/ HollOw l~ ~L ,,t '1 9 El, · r ~o~