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Home My WebLink About9195-zFO~ NO. · TOWN OF $OUTHOLD BUILDING DEPAHTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupnncy No.Z?~. 6 ....... Date ............ A.qg.. 22 ....... , lg. 27. THIS CERTIFIES that the building located at . .The. L. Qng. ~'(a¥ ............ Street Map No. Pebble. i~ea cl~lock No .......... Lot No .... 71 ..... Eaat. [i~.ion .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Ap~.. '~9, 19.??. pursuant to which Building Permit No..919.~Z · dated ........... ,%v=l.l...1919. ?.~., was issued, and confo~-ms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~'.ivata .one..family. d~;el~ lng ...................................... The certificate is issued to . ~Ir.s .Agnes. t~t~sso ........ (~, ~ar ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Aug . 22 .. ~ 97.7 .. by..!~ ~ .V. tlla... UNDERWRITERS CERTIFICATE No... K~9~0.~ ..... Aug...b~...~.~7.? ............. HOUSE NUMBER .. baS?0 .... Street . .-~he- .I~er~g- -lfay- ...... ~. ¥~.~ien. ..... Building Inspector FORM NO. 2 TOWN OF SO~THO£D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9195 Z Date ............ u ................. '*' ..... ; ................. Permission is hereby granted to: .......... ~.r.[.....~5..n..a...o..r.a~..,..2~. ......... ~.~.~; L~t prem!ses located, at LOnG ~.1 ?eb~te ~e.~g.~. ~ '~ ~-~..:..:.;....:.~ ............................... ~...~~ ...... .~.,...~....~.~ ........................................ to ~ppli~tion dated ~Z '~ ,~ ~ ~,Z~.] ~ . .................................................. 19. ~, and approv~ bg the ildin~ Inspector. ? FORM NO. $ TOWN OF $OUTHOLD , Building Department 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 ar Engineer responsible for the building. 5. Subm,t Planning Board approval of completed s~te 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 $1.00Date('"~(~./~ %~-'z.~- ~ '~ ? New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................................................................................................... ~ner Or O~ners Of Property ~..~Z.~ ..... ~/~.~....~:~s.~.L~.~Z......~.~.~....L.r.../.~.d//:r?..~.:~: ........... .(...f.Z. ..... '. ..... ~ ............................ ~ ............................ Subdivision ~Li. ~CH ~ ~ ~ Lot No...~.Z ..... Bilk No. House No.~[.~:~ PermitNo .~]~.~... DoteOf Permit ~.~.l~Z..Applicant ..~.~..~..4:.~ ........................................... Health ~pt.-- ///'Approval .~Z..~.~..Z.~.~. .................... bbor ~pt. Approval U.d. ra,er ..................... Appro ........... ............... Request For Tempora~ Ce~ificate ........................................ Fin~ Ce~ificate ...... ~ ............................. Fee Submitted $ .................................... Construction on above described budding and permit meets all applicable codes and regulations. Sworn to before me this ppz~ ........................................ '-. .................. ~ .~ ............ ~////"-";""'v':~:/ 7 ................. 4C~... day of .... .C'~ .IL, L.q. ~./. ............... (stamp or s~l)O/)~"'-~ ~//~ _ Not?fy Public ...... ~../~./~. County ~ .... ~ NOTARY PUBLIC, State 0f New York H0 52-8i25850, Suffolk Cou~ Term Ex~ims March ~, THE,NEW, YORK,_ BOARD OF FIRE UNDERWRIT,EE$,,, hh * ,',~ , ,', t1' ~ , '~ ~'_~'~,, BUREAU OF ELECTRICITY " 85 jOHN'STREET, NEW YORK, NEW YORK '10038 only the el~tr~cal equipment ~ described be~om a~ [nt~uc~ bY the applicant named o~ $he abo~ application number in the premlses of, A. ~usso,~.The Long WaY' ~67~0~ ~East-Marion,'~L~.~.~ in thefollowinglocatlon; ~ a..~.t ~ ~str[.~ ~ ~nd fl. outside , ,, ~, und fm~nd to be in compllaneo w~th the requirements of thi~ Board. ,,,,,,~a,,,~aedoa August l, 1977 ~', ,, FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS OUTLETS SWITCHES FLUOReSCeNT OR~'ERS FU,NACE ~OTORS ~EDEES T,~E C~OC~S U~'T"E^TERS mM~ERS SYSTEMS NO OF SERVICE DJSCONNECT.~ ~ · S .... E OTHER APPARATUSi NO OF CC COND ' PER .8' R V I C E e " *Future Applianc . Feeders: 1-3#10, 1-2#12,1-3#6 i G.F.I. 2 Smoke detectors Joseph Crocombe Box 71~5 Center Moriches, This certificate must not be altered in any manner; return to the ~ffice of the Board if incorrect. Inspectors may be identified by theh TOWN CLERK'S OFFICE-~?~.~ Permit ~o .... ~,~ .............................. Disapproved a/c ...... ~ ........................................ .. ..................................... .......................... CATION FOR BUILDING APPLICATION FOR BUILDING I NSTRU~IONS a This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildir. 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 pubhc streets · areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatior 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 wdl issue a Building Permit to the applicant. Such perm 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 o Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe· The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if o corporation) .... ~ ........................ ,/ , ............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder · ..................................................................................................................................................................... Name of owner of premises ..~....%~ 6~ ~J¢~ ~--~ t -~ ~-~ If apphcant is a corporate, 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. Map No t?~-O~..t-~...~.~.F.H,....~..~.,~'.. Lot No...-?./. ............... Street and Number ...~...~[Z~Z....../~.....?...~........~/...~..~.t .................................................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisitmg use and occupancy ........................................................................................................................ b. Intended use and occupancy ...~, ....................................................................................................................... 3 Nature of work (check which apphcable). New Building · v' Addition Alteration Repair ................. Removal ............ Demoht~or. ....... Other Work .................................................. (Description) 4 Estimated Cost .... ..~..~.....~...~....?. ................................ Fee ...L?...~.....~. ............................................................ (to be paid on filing this application) 5 If dwelling, number of dwelling units .... ..~....N.....¢~.. .......... Number of dwelhng umts on each floor ......................... If garage, number of cars . ~........C~..,. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7 D~mens~ons of ex~stmg structures, if any Front ..................... Rear ................................ Depth ................... Height ........................ Number of Stones ......................................................................................................... D~mensions of same structure with alterations or additions Front .................................... Rear ....................... Depth .......................... Height ....... Number of Stories .............................. 8 D,mensions of entire new construct,on Front ..~...~ ........................ Rear .... ..~....~. ................ Depth ....~....~. ............. Height ...,~ ~ .......... Number of Stories . ...'~.....,.,~..~ (.~o .... ....., ......................................................... . ................ .... 9 S~ze of lot: Front .... O~..~. .......................................... Rear ........ (S~.~.. ......................... Depth ...~,.~.....9~.. ................ 10. Dote of Purchase ..... ~J.~..2..~/. ................................ Name of Former Owner .~ff~..~.b-~...~..~..4..~(.~.....(..2~....~..c.~Z'..: ..... I 1. Zone or use dmtnct in which premises are s~tuated .... ~.~';).?..~..¢.¥.~...~...~.. .......................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ~ ..................................................... 13 W~II lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ( u)/No 14 marne at uwner of prem,ses ../~.&..~ ...............o. ................... Address..~.~e,0~.~Jl~..l?.,~. ......... Phone No ...................... Nome of Architect .C~\ ~...~... ~ .9. -~.~..~. ............ Address .~,4~ft?..~.~..~.-.....~.~ ...... Phone No ...................... Name of Contractor ~..~ f--o~J"~'T'~-- fZo,~, . ........... g-~ /.4,,~-~,~,~-~ ~)~. . ..................... ................... Address P/~'C'E:"~ ...... Phone No~/ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property lines Gwe street and block number or description according to deed, and show street names and indicat, whether interior or corner lot ~ ~0o STATE OF NEW ~~' ~ c c COUNTY 0~: .... .e~"~.X~...~. ~..Z ....Z~ ~ ~ .~..~ t.~.~.~ ..~.~,~.~ ............................... be~n~ duly sworn, deposes ond soys thor he ~s the opphcor (Nome of mdiw~uol s~nin~ contract) obove nomed He ,s the .~.'..~.~... ~....~...~ ..... .~.~.~; ....... ~: ............................................................................ (Contractor, agent, corporate officer, etc) of sa~d owner or owners, and ~s duly authorized to perform or hove performed the said work and to make and fk th~s application, that oll statements contained in this apphcotion are true to the best of his knowledge and belief, a~ that the work w~ll be performed ~n the manner set fo~h m the apphcat~on filed therewith. Sworn to before me th~s .............. ~'~' day °~''' 197~ /.Z~/ ~ Nota~ Pubhc, . ....... Coun~ .... ~~.~.~//~ ............................................... (~/e ~pplicant) IIF I",F~'I I'f~'N,i OF HF..ALTH THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OB FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR TH~S RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMEI OF HEALTH SERVICES APPLICANT. ADDRESS __ TEL ______ ( vacant l Open Space REVISIONS AUG 5,/97'X cot 70 (vocan!l Lot 71 Area = 21,762 scl'ft' NOTE. SUBDIVISION MAP FIL ED/N THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE II, 1975 AS MAP NO 6266. · -- MONUMENT YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOUNG SURVEY FOR: AGNES /?US.CO lOT NO. YI,"PEBBLE BEACH FARMS" GUARANTEED TO' AT EAST MAR/ON TOWN OF SOU THOL O SUFFOLK CO., N.Y. SCALE / '~-- 40' THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY OEPARTM£~ OF HEALTH SERVICES APPLICANT ADDRESS TEL ___ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE HS REF. NO. , APPROVED eF45~ (voCODf~ HF,, OpeD Space Lot 70 ( vacant ~ Lot 71 Area = 21,762 sa.ft. NOTE SUBDIVISION MAP F/LED IN THE OFF/CE OF THECLERIf OF SUFFOLK COUNT Y ON JUNE II, 1975 AS MAP NO 6266 · -- MONUMENT REVISIONS YOUNG & YOUNG 400 OSTRANDER AVEHUE, RWERHEAD, HEW YORK ALDEN W YOUNG HOWARD W, YOUNG SURVEY FOR. AGNES RUS$O LOT NO.?I~"PEBBLE BEACH FARMS" THE LOCATION OF WELLS AND C~,SSPOOLS SHOWN HEREON ARE FROM FIELD ORSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENC~ WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMI OF HEALTH SERVICES APPLICANT 'T'G~ C_E.~.L~_!~_~dc..~to_.~.~C-o___g? ~tC- SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY APPROVED _ C' ( , ( vacant Opet~ 'SPace Lot 70 ( vacant Lot 71 Area" 21,762 sq' fI' SUBDIVISION MAP F/LED IN rile OFFICE OF THE CLEE OF SUFFOLK COUNTY ON dUNE II, 1973 ~S MAP NO 62, · = ~ONU~ENT REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, R~VERHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOU~ SURVEY FOR. AGNES REYNOLDS LOT NO. 71;'PEBSLE 8EACH FARMS" EAST MAR/ON TOWN OF SOU THOL D SUFFOLK CO., N.Y. GUARANTEED TO SCALE /'~40' JDATE