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Home My WebLink About7069-zFOEM NO. 4 TOWN OF $OUTHOLD BUH~I)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.. Z~98~ ..... Date ............. July, · · THIS CERTIFIES that the building located at .Ra~lel'. Road~ ............ Street Map No..T.~rry..~&~;.e~ock No ........... Lot No... ~) ..... l~o~ltlmld.. H,Yo ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Jai~.. 22- ..., 19..~ pursuant to which Building Permit No.. ~O~Z. dated ............... Jail..2~ 19.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P;~,~ta.~e. o~e..fe~],y, d.w.e~l;Ia~g ....................................... The certificate is issued to . ,Toby. & .]~e. · ~tmlltl~ .... O~zlel'$ ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval - ~.illy..-$ ...~.9~ .... by 1~, .V~..1.1&.. UNDERWRITERS CERTIFICATE No .... N .16.~P~ ..... 3ur~ .. k~.. · ~ .......... HOUSE NUMBER .~?~ ......... Street ...Paai~bler, .Pea& ........................ Building Inspector ':1 ........ FO~M 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) No. 7069 Z Permission is hereby granted to: ~..o...~...y~..~.o.~.s.~.~.....[.n..~.:.....A/..~.~.o...~......~.:...~.s..se~n~ & ~t, ....... ~2~.~ .......... ~m~:;l,a#...~. ........................... ....... ~.~.~3,~. ......... ~.~ ....... .1.1.7.~ ............... to ~.~,~,~..~...~x~...(~L3,~r...~.~ ~J,~g ...................................................................................... at premises located at ,~..0...~......~..0.. ...... ..~.,e.,~....~...~..t,.?.,.~ ........................................................................ .............................. ~/~..~Xe~..~c~ ......... ~o~tt~alzl,....,~...~.. ................................................ pursuant to application dated ................... ~T.~,~, ......... ~,~ ............... , 19~1:..., and approved by the Building Inspector. Fee ~,~, · ~..~. .............. ..f...~.~,~.~ ....... ~ ....... : ......... ~ ................... .~. ................ Budding Inspector l FOI~M NO. 6 TOWN OF $OUTHOLD Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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 installations, 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 property 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $!.00 New Building ..../,~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~...~.~.......~../F~'.~..~...~..~I~ ...... .~.~. ........ ~.~./r~.~.,2. Z.~.. ...... Z~...~.. ....................... Owner Or Owners Of Property ...~.~_~.....f~...~..~..~.~).~.......~.~.~.~..~.~...~..~-- /~-/~/~..~..~.-...-.'~-.<.~ .~..~....(~J~.~.£./~.~...Lot No..~..... Block No ............. House Subdivision No...~...~,.-- Permit No...~...~....~..~...~-.. Date Of Permit ..~.7...~...'z..7...~....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. Sworn to he. fore me this Applicant ............... ~ ........ ~~.~ ................... / 'f~ ........ l.:...~ay of .....,.....:~fl...~..~....?...~ (stamp or sea~_~ ~ ~ota, Public .~~.. County' j 7~~. ~/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~-k EUREAU o~ ELECTR"C~ :~. ~ 85 JOHN STREET, NEW YORK, NEW YORK t003a ,,..,. J,...,. 27. ,7,, .,.,,.,..,.~o.o.,,,. 72, 290 N 167929 THIS CEI~rlFIES THAT. only th~ el~trical equipment as d~scrib~d b~iow and introduced by th~ appli~ant namad o~ tI~ abo~ application number in th~ prem~ws of John B. & Hel~ne WaasunE, e/side Rambler Rd.. qO0' s/o Bayv~ew Rd. ,. ~outhold~--~. I. · thefoll4~ingloeation; [~ e,,e,~nt ~ l,trt. [] 2~ ~. outside s~t/~,, m~ tot ~ e.,.,.i,~ o. JUne 2 q. 19 7 q o~yo.~ to ~ in eom~ia~e with t~ ~uirements of thh ~. fiXTURE ~EPTA I r [ fiXTURES OUTLETS ~E~ CI.ES SWI CHES iNCANDESCENT[ FLUC~E.~CENT i ~ DRYERS [ FURNAC~ MOTORS FUTUREITL Ai~tjANc! FREDEKS AMT. K.W. O1[ H.P. GA~ H.P. AMT. NO. . R COOKING DECKS [ OVENS DISH WASHERS 'rp*4~CLOCKS4 ~ IUNITHEATEKS MULn-OUTLET V I C E 1 'Furnaces: Oil 1-1/8bp, 1-1/15hp Moto~/s: 1-1/2hp EXHAUST FANS DIMMERS Let Electric 56 Dunn Cou~t, 5ayvllle, B.I. 11782 COPY FOR BUILDING DEPARTMENT. . THIS COPY_ _OF: .CERTIFICATE. E~M~/:~/~_::: :;!xNOT_~ BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~Phone~ Address xv--~~- -- . ~---~-~ 2. Property -to~a~l-6n ---, r -7 Village ~0~7~0/~ Township 3. Public Water CompaQy. Name 4. Lot size: Width~ ~ feet Length /~ feet 10. 11. Sewage_ Disposal System: . :~. Lea~l~ing pools: ~ Nul~t~r of poo Precas~,~-O BIock Speci al If priyate well, fill in the follo~g blanks: A. Ta~'capacity _~J~llons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well 5. Subdiv. ~r~-~ 6. Section~ 7. Lot Number~ 8. Private Well )~'~ 9. Public Water' Distance to n~in (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date Signed ........ )~M)m)m( .... m) ........... mmV) ........... m ....... mmm)mM)()mmm .......... Mm)mm)))mmmm FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this pl~ot. APPROVAL DATE /~/~ ~/~7 SIGNED ~ .~ ___ S-15 Rev. 4/1/73 '* T ~ · ' TOWN OF SOU HOLD ./~,~/~./ _~ - . ~ g~ ~u~xN~ ~ir~rrMmT~'//~ ' ~.. ~ ~ ~ ......... ........ , .......... ........ *'T~ifi~~i'"~ .................. INSTRUCTIONS e. This,~tpptleatien must be Completely filled in by typewriter or in ink and submitted in triplicate to the Buildhlg Inlpactor, with~ 3 mu of Idem, leemite Mot peen to scale. Fee acomcllng to ~hedule. b. Plot plln ~howing location of lot and of buildings on premise~, relationship to adjoining premises or public streets or areas, and~- giving e detailed description of layout of property must be drewn on diagram which is part of this application. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approved of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shall be kept o the premisas evalleble for inspection throughout the work. e. No building shell be occupied or used in whole or in pert for any purpose whatever until e Certificate of Occupancy shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iuuenca of a Building Permit pursuant to the Building Zo~ Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, f~' the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The alNdicant agrees to comply with itl alN311cable laws, ordinances, building code, housing code, end regular ions, and to admit authorized in~poctors on premises and in buildln~ll for necal~W inspections. (Signature of applicant, or n~me, if a corporation) (/tu:ldress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general co~tractor, electrician, plumber or builder. · . .................. ................................................................................................................................................. Name of owner of premises ............ ..~..0...~.."~'.....~..:......~....~..~-~.......~.,~.....~..~..~, .................................................. If applicant is a corporate, signatu.re of duly, Ruthorized officer. (Name and titl6 of corporate officer) Builder's License No .......................................................... P umber's ~icense No .......... ./.....~.....~......?.. E ectr c an s L cense No ..... ===================== .... Other Trade's License No ................................................... 1. Locetonof andonwhich ro d work will be done Ma No ..~...~..~.Z .... L p ~ .- . ~ap_ ...................................................................... Street and Number ~ J'' /~(~?' ~-)' .......... Z ..................... ............ ............................... ........................... Municipality 2. State exi~:ing use and o~upancy of premises and intended use and a. I=xi~ing use and o~upanc¥ .................................................................. 2~:{..;"..~?~......,.~'.'o..~:.~ ........................... b. Intended use and occupancy .... ./..~...~...~?...Z'.~.~'.. ~ ......... ;...,~.,:....~,~...~,,, ..,,.;....;.(...~...~ ........... ., .............. ................ 7" ' 3. Nature of work (check which apolicable): New Building .............. Addition ..................... Alteration ...... :. ....... Repair ............ Removal ......................... Demolition ........................ Other Work .................................... ............. (Description) 4. Estimated Cost .. ~ ............. Fee .................................................. (to be paid on filing this application) S. If dwelling, number of dwelling units ....... / ....... Number of dwelling units on each floor ......................................... If garage, number of cars ............ ~ ....................................................................................................................... 6. If business, commercial or mixed occuoancy, spe~cify nature and extent of each type of use ..................................... 7. Dimensions of existing~tructures, 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 .......... ~...~.. ........ ¥.~,1.~. .......... Number of Storie;~.f,~../ ............................... ~Z~..=-C.. .............................. 11. Zone or use district in which premises are situated ................................................. ~ ............................................. 12. Does proposed construct~jCll_a,te any zoning law, ordinance or regulation: ...................................... ~ ................. 13. Will lot be regraded .... ,...s~e..~.~'./.~c~l~moved~roV~:p~Jr~,~{ 14. Name of Owner of ~..X~...~.~r,h~me'J:.....~.-J~.,.,i.~.~.~:,~[ ..................................................(Phone No.) .ameofArch t ..... ....... ..... Name of Contractor (Address) (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 number or description according to deed, and show street names and indicate wheth- er interior or corner lot. .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly-~!u/thorized to perform or have performed the said work and to make and file this application; that all statements contained in this aPp~!icatio~ ~re tru~ to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the al~plication file~:therewi~th. ' dOH N T ® o TOMARK CONSTRUCTION INC 5250 SUNRISE HIGHWAY SAYVlLLE, NEW YORK 11782 LT - -:~,,~ :1-, BUILU~NG DEPARTMENT '~. 9AM TO 4PM FO& REQUIR- u~'O~;~ BACKFILLING FOUNDA- ~., ~R START FRAMING ,. Uu,-~k~ COVERING PIP~LINE 3. i-INAL WHEN JOB COMPLETED i NiO~ll 5LEVATIO~ CF, O ,~:~ ~Tl~:~/'~ L~rT ~. LEV/~T IOM