HomeMy WebLinkAbout13856-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z14590 Date July 2 19 86
THIS CERTIFIES that the building One family dwellinq .
Location of Property 1045 Washington Avenue Greenport
House No. Street Harnle¢
County Tax Map No. 1000 Section .0.4.1. ........ Block . .0.2. ........... Lot 11
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... ;~g~7oh. 3. ], ........ 19.8.5. pursuant to which Building Permit No...1. 3. .8.5.6. Z. ............
dated ....ApKi. 1...1.1., ............... 19..8.5, 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 .........
.O.r,,~..f.a.m.~ .ly. dwelling.
The certificate is issued to .... RORY KLINGE AND KATHY M. KLI.N.G.E
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval 8 5- ~ O- 41
UNDERWRITERS CERTIFICATE NO ............ $7 5 5.0.4 ~ ..............................
Building Inspector
Rev. 1/81
FORM' NO. ~1
TOWN 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)
N~ 13856 Z
Permission is hereby granted to:
.........
...... ..?.~./.~..,.,.tM.....~. ....... 4./..~.-~.....
,o .....~ Af. ,2.T/. ~G'~..... .,,:fL . ..~..~ &. ....~,~.z /..,~... ..~2t ,,~-Z,,~ L ~ ~ ........................
o, premises located at ..../..O.....~...~......,.~....~/~././~..C~...~....~.~.~' ................................
.................................................................................................. ~.~--,~.~,'.:~..,,..x~ .~
County Tax Map No. 1000 Section ....~.....~../.. ...... Block ..... .(~....~ ....... Lot No....~../../. ...........
pursuant 'o application dated ..... ~/~ ....... ./../. ............... , 19~....~.,~nd approved by the
Building Inspector.
Fee
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
.?~uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPAI
Instructions
A. This application must be filled in typewriter OR ink, and submitted~a~teto 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 sur~ey of peoperty 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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling / land use
3. Copy of certif cate of occupancy $
--Pre-Existing C.O. $15.00
Vacant land C.O. $ 5.00
June 26 1986
Date ....... '
New Building ..... X..X ...... Old or Pre-existing Building ............ Vacant Land .
1045 gt
Location of Property ........ Washin on Avenue Greenport
House lVo. ...........................................................
Street Hem/et
Owner or Owners of Property Rory Klinge and Kathy M. Klinge
County Tax Map No! 1000 Section 041 02
...... Block - 011
................ t ....... LOt .......
Subdivision
.............. · ............ Filed Map No ........... Lot No ..............
PermitNo. 13856 Z DateofPermit4/11/85 gory & Kathy M.~ Klinge
.......... · Applicant
Health Dept. Approval ... June 23, 1956
..................... Labor Dept. Approval ........................
Underwriters Approval .', June 12 1986
...................... Planning Board Approval ......................
Request for Temporary Certificate ......
. .~.. ff ............... Final Certificate...X.X. ........
$500 ......
Fee Submitted .... .....
Construction on above described building and permit meets all applicable cod~s and regulations.
Applicant. ~,.~... ~
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date July 3, 1986
Building Permit No. 13856 Z
Owner Rory & Kathy M. Klinge
(please print)
Plumber K & K Plumbing and Heating
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
Swo~/to before me this
?~b/day of July
19 86
Notary Public,
(plumber' s signature)
Notary Public
Suffolk County
~ ~ COMMENTS
FIELD INSPECTION
FOUNDATION
(1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
qODE
FINAL
ADDITIONAL COMMENTS.'_______
THIS
BOARD,OF FlEE UNDERWRITERS
b~lova a~ tnt~uced by the applicator trained on the a~ve application number i~ tl~e pretn~se~ of
GENEEAI.
be idehtifi~d by thei~
765.t802
BUILDING DEPT.
INSPECTION,
[ ] FOUNDATION 1ST ROUGH PL G.
FOUNDATION 2ND [ ] INSULATION,
..~_ RAMI~G [ ] FINAl.
DATE ''/ ~,~i INSPECTOR
765-1802
BUILDING DEPT,
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[] FOUNDATION 2ND [] INSU~LArlON
[]FRAMING [/~J' FINAL
REMARKS:
DATE INSPECTOR
' FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
· ~OUTHOLD, N.Y. 11971
~,~ //' 19~~''-
Examined ...... ffF~"~YZ
Approved .. .......... ~i .... 19~.~.'~ermit No. ? .........
Disapproved a/c ..... ~...~ ...... . .~.../
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ,19...
Date .... I.~.a.r. qh...1.1. .... ,198.5.
INSTRUCTIONS
a. This application must be completely filled in by typewriter erin 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 what_ever 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 necessary inspections. ;
(Signatureofapplicant, orname, ifacorporation)
(Mailingaddressofapplicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumb, er or builder.
Nameofownerofpremises Rory Klinge and K~-bh~ I~5. Klinge, his wife (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 License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done...!-.0~.5. ?.a?.h.J:..~.g.~.o.n..A.y.~.n..u.~?. ,g,r.. ?.e?.p. 9.r~ ........
House Number Street Hamlet - ' -
County Tax Map No. 1000 Section 0gl Block 0£ Lot 011
Subdivision ..................................... Fi/ed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
V~csnt ]_and
a. Existing use and occupancy .....................................................................
b Intended se and occupancy O~e-fsmily dwelling
I X'
3. Nature of work (check which tpplicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal ............ Demolition Other Work
,u~'''-a~ ' -~ _ ..~ ,~'fO (Description)
4.. Estimated Cost . .~.'..~.~ .... : ......................... Fee; ......... ~,., ........................
' , .... ~ , (to be paid on filing this application)
5.If dwelimg, nu~e~el ng units ..... ~. ........ Number of dweiling units on each floor ................
If garage number of cars :
6. If business, commercial or mixed occupancy, specty nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................
D~ensions of same structure With alterations or additions: Front ................. Rear ..................
Depth ................... i' '" HeiSt ...................... Numbezof Sto~es ......................
8. Dimensionsof~i[enewconstmction: Front..ga......... !6 Depth. ti ......
Height . .~ .t~ ....... ¢. ~ber of Sto~es [~ . ~ . ' ....
9. Size of lot: Front .!. ~ ~ ,~ .~ ,~ Re~ ~6,1~ ...... ~;~ ......................
10. te fP 7/17/~q ........... ~-~ ........ · ........
Da o urchase ...... R~cha.~d &
...... Name pf Foyer O ncr ..............
.... , . . ttil e ..
1 1. Zone or use district m which p~emlses are s~tuated. Resmde~t~ ,1~ ~rm cultural
13. Wffilotberegraded Yes ~ ....
N~e of Architect , Pho
...... , ................. Address ................... ne No ................
N~¢ of Contractor ' Address Phone No
Locate 'clearly and distinctly all
property lifles. Give street and block
interior '
or corner lot.
PLOT DIAGRAM
buildings, whether existing or proposed, and, indicate all set-back dimensions from
number or description according to deed, and show street names and indicate whether
STATE OF NEW ,~OR~K^,.
· ~UFFv',~ $.s
coubrr¥ OF .'~ ............... ,
RORY KLINGE J .............. being duly sworn, deposes and says that he is the applicant
(Name of individual signiOg contract)
above named:. !
He is the '
(Contractor, agent, corporate officer, etc.)
of-~aid- owner or owners, and is duly! authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner ~set forth in the application filed therewith.
Sworn to before me this
' ;day of i ' 19
5
CERTIFIED TO: :~ :;:
THE TITLE GUARANTEE
NO, T~84 1969
RORY KLINGE 8KATIqY KLINGE
I,~8. G
V/L L A GE
AREA.. I0, 180 sqfUO. 2S57acres)
:E FND
OF GREENPORT
donack associotes
I[ Iond suryeyors ~consulting engs,
1140 west moin street
* [[riverheod,new york 11901
Il
(516) 369~.7717
.~,~NE~' -~*~-~._~ no. ,84-.5,33
~ll_, OD o-o4:-_OL.~¢,e:
I': 250
N/F REEVES
"W
pIPE FND
VIL L ,4 GE
AREA.. /0, 180 sq£t(O. ZJJTQcre$)
OF GREENPORT
PI~ 'E FND
MAP OF
DESCRIBED PROPER T Y
NEAR GREENPORT TOWN OF
SOUTHOLD SUFFOLK CO,. N. Y.
CERTIFIED TO:
THE TITLE GUARANTEE CO.
NO. TI284 1969
RORY KLINGE 8 KAT/"IY KLINGE
ldonock ( ssocietes
land suryeyors ~ consulting engs.
40 west main street
riverhead,new york 11901
(516) 369-1717
JUNE 19,1984 Job no. 84-535
1000-041-02. ,Scale:l%30'
L~- ~=0 ii. oo0
(RES.}
. TEST HOLE
~REA.- /0,/80sqfn
~I/F REEVES
~. o°65~
~T/ONS IN ASPUMED DATUM
ESCRIBE O PROPER
EAR GREENPORT TOt
SOUTHOLD SUFFOLK CO,. N. Y.
CERTIFIED TO:
THE TITLE GUARANTEE COMPANY
N°- T-
SOUTHOLD SAVINGS BANK
RORY KL INGE
K~dTH Y KLINGE
~donack associotes
IQnd surveyors ~ consulting engs.
40 west main street
riverhead,new york ~1901
(516) 369- 1717
JUNE 19,1984 Job no. 84-533
1000-041-02-ii Scale: 1%
,~JFFOLK GOUNTY HEALTH DEPARTMENT
~ SINGLE FAMILY DWELLING ONLY -~..
i ~ ,.D."EF. NO. ' '
t ~ DATE N~'~- _ /~ ~' ' i '
P
OF'
DESCRIBED
PROPERTY
~ . ~ 0,. C,~. ~.~. ~ ..~_ '.' ii ~' NEAR GREENPOt?T TOWN OF
"" Chief of Walte~vltef M&r~ge~ent ~eoti°n ~-~ -~'' '.
......
"" "" ~'~"~ '\' '~" " "' ~11~" ~" ~ SOUTHOLD -.SUFFOLK CO,. Al. Y.
rEST HOLE ~ ~ . I
- t~ ~ .
N~ T- 12~-5277
~~ S¢~ %, ~ ~ ~ ~ - .
~RY KLIN~E
. % ~,~ ;--~ ,~ donaCk associates
". 40 west main street
~../~/80sqff(O. 2~57~cres) (~A~) ~ ~ riverhea d, new york 11901
(516) 369-1717
JUNE I~ ~84 ~ob no. 84-533
~.~--~-z-~ 10~-0~1-02-11 Scale: I" 50'
~0~' EC~AT/ONB IN A~ED DATUM
for water d~strtbut g
sys em; piping shall be
of types K or L only
SOLDER USED Lr~ ~VATE,~
· ~UPPL y SYSTEM CANNOT
.EXCEED 211o of 1% L.~AD,
~d
o
O
F---i F 7' 'T
-J ~ L ~" L .J ~'- 6"