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Home My WebLink About21765-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22727 Date NOVEMBER 15r 1993 THIS CERTIFIES that the building Location of Property 1100 RAMBLR~ ROAD House No. Street County Tax Map No. 1000 Section 88 Block 5 Subdivision Filed Map No. ADDITION soUTHOLD~ N.Y. Hamlet Lot 17 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 25r 1993 pursuant to which Building Permit No. 21765-Z dated NOVEMBER 8~ 1993 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 DECKADDITION TO EXISTING ONE FAMILY DWELLING "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNUPERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A RALPH REIERSEN & CAROLYN ASPLUND / J Bui%ding Inspector Rev. 1/81 FORM NO.3 TOI/~I OF BOUTHOLD BUILDING DEPARTMENT TOWN HAIL $OUTHOLD, N.Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 21765 Z .,~ .,~Pe.,t~mlss_Lon Is hereby granted to'., ~. ~'~'(,~,,~ ~..,./..,C~....~.~ ....................... .... ~:.~ .. ~,,..~~...~ ................................... ~,~ ~.,/~ ~, ~xl. . 117 ~/ 7 __ ~?~.'~.,-~..~..... ~.. ~./."~.......~ ............................. ,o...~..,~,.~ ....... ~ ....... ~~. ........ ~....~~:~ ........ .......... ....... ....... ......................................................... ' ................................................................. ~~./.,...~ ........................................... CountyTax Map No. 1000 Section ....... ~,..~.. .......... Block ........... ,~..~, .......... Lot No...,./....Z. ............... pursuant to application dated ....... ~.~.../../...'~'.. ................................... 19.~..,.~.. ....... and approved bythe Building Inspector, ~ ~ Rev. 6/80/80 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 1. ew Construction ........... Old Or Pre-existing Building ................. (X) Deck as built ocation of Property .... ~P.~ ............... ~f~b. ler. ~Q~ .............. ~O~9~ ..... House No. Street Hamlet ' ' .... '~wer or Owners of Property..~p~'.~p~.~.DD.~.~y~%~.A~p~BD~ ........................ )unty TaR Map No 1000, Section...O~Q .... Block .... Q~,OD ....... Lot...P3.Z,QP~ .......... ~bdivisi°n''~9''r~Y'~9't?~-9~..Ba..5~.~ ........... Filed Map.~PP% ...... Lot ...... ~ .............. :rmit No ................ Date Of Permit ................ Applicant..gD~.g~.%~D~ .......... 'alth Dept. Approval .......................... Underwriters Approval ........................ '. arming Board Approval ........................ quest for: Temporary Certificate ........... Final Certicate...~ ....... · e Submitted: $. 25.00 - .................. .................. ~ 0 ~'~ APPLICANT Ralph Reiersen April 9, 1957) non-conforming uses, or buildings and Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 1. Certificate of Occupancy - New dwelling $25,00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Build~ng - $i00.00 3. Copy of CDrtificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5, Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 For existing buildings (prior to "pre-existing" land uses: 1. for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/I0 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from archiuect or engineer responsible for the buZlding. 6. Submi~ Planning Board Approval of completed site plan requirements. Examined .//. j rJl' 2 5 'FORM NO. 1 'rOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ........... 19~.. Permit No. ~./?. Disapproved a/e ..................................... APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date...Otg. q~er..~5,..,1993. INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 cov~ied 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 pre, inises available for inspection throughout the work. e. No building sh~tll 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 issiaance of a Building Permit pursuant to the B~lding 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. (Signature of applicant, or name, if a corporation) ; N/A (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Own~ r Name of owner of premises ...R.a..l~.h..R..e.i.e.r.s..e.n..a.~.d...C.a.r. 9 .ly.n' .A..s.p.l.u.n..d ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer, .............. ?/5 ............................ x (Name and title of~orporate officer) . Builder's License No ...... 77' .................. Plumber's License No ..... 77' .................. Electrician's License No... 7' 7' .................. Other Trade's License No.. r:- .................. 1. Location of land on which proposed work will be done~ ................................................. 1100 Rambler Road Southold House Number Street Hamlet County Tax Map No. I000 Section 088.00 Block 05.00 Lot 0.17.00.9. Subdivision Terry Waters at Bawiew Fil d M p N 2901 36 ..................................... e a o. Lot........... .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Deck as built b. Intended use and occupancy .. D.eck as built 3. Nature of work (check which appligable): New Building . ,, ........ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition . Other Work .D.e.c~ .a.s. built ,Y'% i (D?scription) 4 EsttmatedCost ]~'~~.Z ~.'~'.. ' Fee .$7.~,p.0 ' ' (to be paid on filing this applicati6n) 5. dwelling, number of dwelling units .............. Number of dwelling units on each floor ................ If garage, number of cars ....... I .................................... ~./alf business, commerciai or mixed o~cupancy, specify nature and extent of each type of use .................... 7 Dimensions of existing structures it'any: Front 7.' Rear 7.' Depth 1.Q ' Height 3 2". Number of Stories ~/.~ Dimensions of same structure with,alteratl°ns or additions: Front .....7:'.......... Rear .....-.-. . ........ N/~epth .... :-.'~ ................ Height ..... :-:- .............. Number of Stories. 7- . ........ .8. Dnnenmons of entire new construction: Front .... . ear ....................... .. Height ............... Number of Stories ....................................................... ..... o, 9. Size of lot: Front . .LZ6 .fiB.' .... ~.. .~-5 ................. Depth . .1.1.~: .4.3.'.. 10. DateofPurchase ~[23/.7.~ I Nameof Former Owner Gy, da Reiersen Zone or use district m which premt~es are situated ................................................ [2 ' ' ' ordinance or regulation: N.o · Does proposed construchon wolateiany zoning law, ............................... [3. Will lot be regraded .... lq~ ~ ' ' ' .... , ............... Will ex~ess fill,be removed from premises: ~ No Ralp.hl Rezersen . Address ~/~i~f~?.~.~. Phone No (5]~6I .549r40~4.. [4. Name of Owner of premises .... l ............. Name of Architect ~/.A ' Address .-- Phone No Name of Contractor ~/& Address ' -- Phone No -- [5. Is this property located wifihin 300 feet of a tidal wetland? ~Yes ..... No 2~... *If yes, Southold Town Trust~es Permit maybe required. i PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and, indicate all set-back dimensions from troperty lines. Give strefit and block nut tber or description according to deed, and show street names and indicate whether nterior or corner lot. TATE OF NEW YORK, S.S :OUNTY OF. · SU~EOLK ....... RALPH R .E IER. S.E. N , (Name of individual signing ~ontract) hove named. See attached Sketch, being duly sworn~ deposes and says that he is the applicant [e is the : .' (Contractor , agent, corporate officer, ere . ) ~x%~l owner nr~n~ne~, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed in the manner seti forth in the application filed therewith. worn to before mo this 15th day of October 19 .93. Public, ........... S.u. ~..~.o.~.k.. ............. County Notary Public I~AB~V, RR DIAG'I'IUN ~m~ ~ ~er 31,1~ kh'~'~/:~'e'~ ......... i~ignature of applicant)