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 ....