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Home My WebLink About12349-ZFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy No ................ Z.1.2308 Date ........ .M.a.rch .... ....... 2. ~ ......... 190.4. ad..d.i.t, ign - THIS CERTIFIES that the building .............. rty .65.0. Rambler Road Southold Location of Prope .. ........................................................... ~ouse No. Street H~mle~ County Tax Map No. 1000 Section . 088 .Block .05. ....... Lot .021 S Terry Waters Fil dMpN 2901 LorN 32 ubdivision .......................... e a o ..... o. conforms substantially to the Application for Building Permit heretofore f'ded in this office dated May 4 8. 3. .1.2.34. ..................... 19. pursuant to which Buflding Permit No. . . 9 .Z, . -dated .... .M.a.~..2.5. ................ 19.8.3., 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 ......... an addition to existinq dWellinc~. The certificate is issued to ..... p.l~,. PAUl. Ro.~$..~..s..n~..~.N.~...~.U.~.H...R.O.S.S. ............... (owner, ~ er-tem~ of the aforesaid building. .nat. .re.qu. ired Suffolk County Department of Health Approval ............................... . .... 638188 UNDERWRITERS CERTIFICATE NO .............. N. ................................ ... Buildin$ Inspecto~ .............. Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. ~' BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC)~PI-k-[ION OF TI-I~WoRK AUTH0~,IZED) N? 12349 Permission is hereby gronted to: ......_~ ~ __~ ~.~..~.~,~_ .,.~:~- ..... ~.~..-...~a~....~.-.~' ........... : ................. pursuant to application dated Bulling Inspector. and approved by the Building Iml~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey 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 certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..//--/ C - ~g New Building ............. Old or Pre-existing Building~. ........... Vacant Land ............. Location of Property .../.,~..~..O. ................ .~..~ ~..(_.~., ./?... f.~. ......... ~.'~. f~.~. ~ House No. Street Hamlet Owner or Owners of Property . .'~...~. :...~.~..~.~........~*...~..~.~.~.'....~...~..~ ..... County Tax Map No. 1000 Section . .~..~. ?. ....... Block .. ~-. ........ Lot...(.~L..../ ........ Subdivision .... i. ,-~/~.. (,/,-~.~ .... Filed Map No..~..?..{).(..Lot No. '~ :2, Permit No..~'.~'.~. ?. ~... Date of Permit .-?/.'~../~',~.Applicant. ~/~.~4-~. ~.., .~¢-~. (4~-t L~..~. ....... 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. I Applicant ............. ~....~~ .................... FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~outhold, 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 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 feat~ res. 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. Rubmit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey 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 safeW inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1,00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..¢.~...../~¢'~.~./~t~'" .~..~.. ..... .... ......................................... House No. Street ~ Hamlet Owner or Owners of Property...~?~..~.~,....M.'..~'....~.~r~-/.R.~;~..~?..~. t.. .~..~. ................ County Tax Map No. 1000 Section ............... 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 ..... · ./J~.~.../..~-.Z'~.-"-,-~-~_._~.. .................. Rev. 10-10-78 THIS CERTIFIES THAT was examined on ~.rc~[1 22, 1984 FIXTURE I ~4 OUTLETS ECEPTACLES SWITCHES 67 FIXTURES IF~CANDESCE NT FLUORESCENT RANGES t 12.7 ~PECIAL REC'PT S R 67 31 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS AfAT~ K W. O1[ H. P GAS H.P. AMT NO. A.W.G. SERVICE DISCONNECT NO. OF METER AMT' ANte' TYpE EQUIP. OTHER APPARATUS: i-~; li~. TIME CLOCKS BELL~UNIT HEATERS MULTI-OUTLET EXHAUST FANS 1 DIMMERS .. SYSTEMS AMT* ~ NO. OF NEUTRALS OF NEUTRAL 411D kkmfsell Lane Cu~ ~hog~e, N.Y. 11935 Lic#2941 GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their/cred,entials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY JOHN STREET, NEW YORK, NEW YORK 10038 ~ F~ 2, 19~ 19'2476/811 ..re ~'p.,,c.,,o. No.o.S,,e N 592066 THIS CERTIFIES THAT only the e~ct~al equipme~ ~ ~8cdbed ~ a~ int~uc~ by t~ ~pli~t ~m~ on the a~ ~plicat~n number in the prem~es of ~. ~ M. ~, ~1~ ~, ~ld, N.Y. in the following location; ~ Basement ~ 1st Fl. ~ 2nd FL Section Bilk Lot w~ examined on j~ ~ ~ ~ and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS IECEPTACLES SWITCHES FIXTURES RANGES :OOKING DECKS OVENS EXHAUST FANS FtUORESCENT DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: E R OF CC. COND, 2/0 C NO. OF HI-lEG 210 Gary Doro~k~ 42D ~cmsell T~ne Ct.q;~, N.Y. 11935 T~t.c#29,U.~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors be COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FIELD INSPECTION · COMMENTS FOUNDATION (1st) F,OUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL l )DITIONAL .COMM.~NTS: , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved//~/~..~..~..., 19~. -~. Permit No../..~..~?..~..~ Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERM IT Application No./~.?-..~..~.~. ....... Date. ?..Z .~. ............ 19 .~.3. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with~3 s~, accurate plot plan to scale. Fee according to schedule. ~ 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 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 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 necessar~inspections. · ................ (Signature of applicant, or name, if a corporation) (Mailing address of pp ' ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises '.~...~.~...~....o~......~...: ~ ................................... (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..~,,~.h,,'~,,T:,,~..',,~,,,~.'~.~.~.~. Plumber's License No .... 7.0,,, .~, ?,., -~,~?.~,%'~·¢/ Electrician's License No.. fa.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................ .................................. · ....................... .......... .............. House Number Street Hamlet County Tax Map No. 1000 Section ~. ,~.', ............. Block , ,.~,. ............. Lot,, ,~-, (, ............. SubdivisioJ~¢~.~, .'.1~,.. ,~. ,../~. ,~. ............. Filed Map No, · Lot ,~,,~ ........... " (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy .... ~~, ,~, · .................... ~- Intended use and occupancy ..... ~~..,'74~(,.~.,~~ ~,~--, 3. Nature of work (check which applicable): New Building ......... itt ........ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ~a.~ _~ %.-~ go (Description) 4. Estimated Cost .... (.z.~p..~.~! Fee ~,~.. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor.. ~.eq~.. q~.~ef~ ~- il,. If garage, number of cars .... ~O...a~.q. .......................................................... 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 ........................................................ Depth ...................... alterations or additions: Front ................. Rear .................. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth Height ............... Number of Stories ............... 9. Size of lot: Front ................................................... 10. Date of Purchase ...................... Rear ...................... Depth ..... ............................. 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. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address Name of Architect ................... Phone No ................ ........................... Address Name of Contractor ................... Phone No ................ .......................... 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 lot. STATE OF NEW YORK, S COUNtrY OF..4~'~...,~..~>.~.,., .S ~ .... ~Z~TY'.... &~,.. ~.~..~../..~. ~./.~...~.. ....... being duly'sworn, deposes and says that he is the applicant (Name of individual signing contract) 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 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./ff/ff~..a~. ............ , 1 .~.. NOTARY PUBLIC, State Of N~W y~ ~'. No. 5a-4~24771 ........... . Commission ~pirt~ ~ 3~ ~ * for water dislributing sysiem; piping shall be of types Kor Lonly ~PPROVED AS NOTED ,NOTIFY BUILDING DEPA~RI'/~ENT AT 765-1802 9 AM TO 4 PM ~T?4E FOLLOWING INSPECTIONS: FOR POURFD CONCRklk I, for woter distributing system; piping shall be of types K or.L only NOTI~ B~UILDING DEP~R~ AT 7~5-1D02:9 AM T0 4 pM FOLLOWI~G INSPECTIONS: L1. FOUNDATION - ALL CONSi~iJ~Iffi A ~lr THE RE~LJ~ ~ ~ N.Y. ~ATE CON~ COD~ ~ ~ DESIGN ~ C~