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HomeMy WebLinkAbout1796-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17430 Date OCTOBER 19~ 1988 THIS CERTIFIES that the building. ONE FAMILY DWEI,LING. ORIENT Location of Property 800 NORTH VIEW DRIVE House No. Street Hamlet County Tax Map No. 1000 Section 13 Block 01 Lot 03 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 25, 1962 pursuant to which Building Permit No. 1796Z dated JUNE 28~ 1962 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 DW~TW.ING. The certificate is issued to MRS. WALTER KRUMBIEGEL (owner, X~) of the aforesaid building. SU~'~'OLK COUNTY DEPARTMENT OF HEPCLTH APPROVAL UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FOl~l~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. , 1796' Z Date ....................... ~,~'~t~e ...... ~ ..... 19.~.. Permission is hereby granted to: ..... gou~u~la ................................................ to .. ;l~J.!a.. ~ew..o~e.. t.~l.Z.y.. ~el.l.~ ............................................................................... at premises located at ..~/~..~l~.~l...~l~v~¥..]~owzl~..]~..1]:S...]~.~.~t~e~ ........................... ......................................... Oz~e~4;'i ..... ~t;~;' .............................................................................. pursuant to apphcahon dated ............................... ~r~ll0 ...... ~ .......... 19.~p., and approved by the Building Inspector Fee $3LO. OD ........... ( r-'~' '~ ~13u~J'c~ing Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLDG. DEPT. ,, , 1'OWN OF SOUTHOLD 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: 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 e~ectncal 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]:opert¥ showing all properW lines, streets, buildings and unusual natural or topograph ic featu res. 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 Dwell-;ng $25.00, Accessory ,$ lO.O0 Business $.50.00 2. Certifmate of occupancy on pre-existing dwelling $ lOO.OO 3. Copy of certihcate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... Newcons true t ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ~ .5~.`...b.N..~'.' .<-t.q..~t.; ............................ C_~..E:..N..~ House No. Street Ham/et Owner or Owners of Property .t~f.~.L.~,~C.~. ,~. ,~,~ .I.,q .~.~ ....¥-3;c. ~.V~ .~,,'., .~, ~.~ L- .............. County Tax Map No. 1000 Section . 3. ~ ........... Block ...... ~ ........ Lot ...... .~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health 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 meets all applicable codes and regulations. Applicant <~--'- ~ ,,oz Jo. TOWN OF SOUTHOLD BUILDIHG DEPARTMENT T~N CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ F"t ................................... ~ ~pproved ........................................ ~9 ........ Perm:t No ........ : ...................... Disapproved a/c .......-~.....: ....................... APPLICATION FOR BUILDING PERMIT Date .............. ...~.U.~'...~.?. .......... ..~....~..~.. .......... 19...G....~,.... INSTRUCTIONS .a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any pu~'pose 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of ai~plicant) State whether applic, ant is owner, lessee, agent, architect, engineer, general contractor, .electrician, plumber or builder. · ....................................................................... Name of owner of prem.se ~ff./,',~,Z'~.....~,~..../t'~)..~. .... If applicant is o corporate, signature of duly authorized officer. ..... ...... .......... ~/ (Name and title of corporate officer) I. 2. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... St d N b ./~4;~.Z?~. ,~.~.~... - Feet on um er ................. : ......... State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ............................... ...................................................................................................... Intended use and occupancy....~.~,x~....~......~.~....~,...~-~../.~;~v5.~,~.. ..................................................... -~...,..t~ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ......... .......... .Other Work (Describe) .................... 4. Estimated Cost ~1~/..~.~ ~ ..Fee ....~.L~.~...~. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ./. .................... Number of dwelling units on each floor...../. ..................... 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 ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front......~...~..~. .............. Rear .. ~'- · · .......................... Depth .~'~ .................... Height ......~.~....~ ............. Number of Stories ......... ./. ................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase .~.~/~,4~/,~',~,i ................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~...~...~ ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ~..~ .......................................... 13. Name of Owner of premises..~eC..,.,~.~.~6~...~./.~-~.....Address .~/~.,.~'~ ................... Phone NO.,~/,...'~.~ Name of ArchitectC/~/.~l~'~.,.... ,~....~./~..~/~ ............. Address ,~.4~'~,',~/~.,...~.~.,~.,......Phone NO.,.~...~...~.~,~s~ Name of Contractor.~¥.~,~X/',~'..~/~..~...~/~'~,~ddress ..,~,,~'~/.Z2.~....~.,~... ....... Phone NO.,~.~.....~...'..~...~...~-~. 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 numbers or description according to deed, and show street names and indica' whether interior or corner lot. ~ STATE OF NE.W~YC~J~.~,.~, j ) S S. COUNTY OF ~.....) ..... .~/~T'..~:2~.....~?/J.~.. ........... ; ................. ~ ......... being duly sworn, deposes and says that he is the applicant (Name 'of individual signing application) above named. He is the....~-~.~.~.......~.;/~--~. ............................................................................................. (Contractor, agent, 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 oil 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 t Sworn to before ,me this JUDITH T ~:~~ ~~!~l~ re of applicant) Notary P ....