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Home My WebLink About9799-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No. Z95J9 Date .M.a.¥. 9 19..7.9. THIS CERTIFIES that the building located at . .~..~.5..R..ar~..b.l.e.r...Rg.a.d' ....... ~k~xxx Map No...2~9.0J ...... Block No ........... Lot No ........ .2.~. ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .June...12 ............ , 19...7.Spursuant to which Building Permit No .... 9.799.Z dated .Juna..2.6 ............. , 19..7.$, 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 ~rzvate One Family ~ellzng With addx~zon The certificate is issued to ....... .J.u.~.~..u.s..&...E.d.~.~.h....D.o.~...~. ......................... ( owner, of the aforesaid building. Suffolk County Department of Health Approval ............ ~J/~. .................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER 185 ...... Street Rambler R. oa.d ............................................... Southold,......... .... New......Yo.rk.. ...... .... Building Inspector County T~x MaD Number 1000-88-5-29 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9799 Z Permission is hereby granted to: ........ o?.~.z.i~..s....F..,..A..~.~.t.~..tt..P.o....~...s. ................. at premises located at .................. J..8...~....R....a~..~.~...R..~.a...cl: .................................................................... ..................................................... ~.~.u.ChQ!.d.~...~W....~Prk.. ............................................................... Lot # 23~ Terry Waters, Filed Map 2901 pursuant to application dated ........... ~.... 12 19 7.8., and approved by the Building Inspector. Building Inspector 1000-88-5-29 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: ]. 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 oil 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 $1.00 New Building ................ Addition ~//f Old or Pre-existing Builds ..... and ........... Location Of Property ..................... ~ ................................ 1'. '~' ........... '7 .......... ~*~/..~..'.w...'~ ...... Owner Or Owners/Of Property ..-~...(4"~../.'..~..,~....~....,,..-'~,..~.~.~...i'.:..~,.~.O. k4~C.~..~. ............. ......... .............. S,,bd,v sion .... B,=k No ............. ,Duse Permit No..~....7...~.~.?..~..:Date Of Permit ..~./..~....~/..~-~.ApplJcant ....'..~.~..~.':.?.~....../..~..'.~..¢?...~....~.,.~ ......... 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 mee~ II .appJ~able codes and regulations, Applicant ~~....~...:..~ ............ :a ........... ~ .................. Swom to before me this ~ ~ ' ~J~~-~" ................ day of ............................................ (stamp or seal) ~ .otary Pub,,c .................................... Co.n,, FORM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Examined .........~"~,e.....~6 ............ 19....~.8 Approved ....... ~T~.--~e..--.~ ........... , 19..~,g.. Permit No .........~O~Z ................ Disapproved o/c {Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .........9?99 .............. o. This application must be completely filled in by typewriter ge in ink and submitted in triplicate 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 o~ areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this opplJcotion~ 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 work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 i~he Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance,% 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, an~ to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owne~,r lessee, agent, architect, engineer, general contractor, electrician, plumber or buJJder.~ ............................. ~t~.: ........... :,....~...~,~ ........... ~:~ ...................................................................................................... If applicant is a corporate, signature of duly authorized officer. Builder's License No ..................................................... ................................................. Electrician's License No. ............................................ Other Trode's License No ............................................... 1~7 . 1. Location of land on which proposed work ~ill ~e done. Map No.;.~f.~>/.~.~.~. L~t No..]~.,.: ............... ,nd .mbe ..................... ....... /.:K,...L. .............. ........................ Municipali~ 2. State existing use ~nd occupancy of premises ~nd intended use and occupancy of proposed construction: ~. Exisiting .se end occup~.cy .......... ~j~.I~[:::~.~,..L'.:.~: ................................................................................ .................................................................. b Intended use and occupancy 3. Nature of work (check which applicable): New Building'. ................. Addition ......~.. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ............................ ~':]lk' .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... l ................ Number of dwelling units on each floor ........ ./. ............. If garage, number of cars ............................................................................................................................................. 6. If basiness, commercial or mixed occupancy, sp_eci%,nature and extent,z,9_f~ea~h type of use ...... j......~:..? .......... 7. Dimensions of existing structures, if any: Front ...~,~...~ ................ Rear ......~...,..~ .................. Depth .~...~.~. .......... Height ...,~ ............... Number of Stories ............................................... ~,~ ....................................... ?; ..................... Dimensions ~f same structure with altercations or additions: Front ........ ::?.,~.~/...~. .......... Rear ...~....~?../.~../..~ ........ 8. Dimensions of eptire new construction: Front ...... /..~e'.. ...... , ................ Rear ..../..~........Z. ........... Depth ../.,,~ ................ Zone or use district in which premises are situated ............ ~..I.~.L .1.'.~2.¢~.....~. '! ..~ ................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ........ ~.......0. .................................... 13. Will lot be regraded ...~../~...~. .............. Will excess fill be removed from pre~ises:~(, ) ~Y~ ~ No~ Name of Architect .............................................................. Address ................................ Phone No ....................... Nome 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 whether interior or corner lat. STATE OF NEWC'~fO~I~,, ~.)^ I,:: ~ ~ COUNTY OF .~l.~l.j.f'''~ / t~.~'......~.~ ...................... being duly sworn, deposes and says that he is the applicant ~ (Name of individual signing contract) above nflmed. He is the ~6~ ~ (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 all statements contained in Ibis 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 ~plication filed therewith. Sworn to b~ me this ~ _ / .... ............. , ;'i;"Z ........................................ "- ~/ ~ / -) ~/ ( I · (Signature of ~plicant) . . i/. '