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Home My WebLink About5738-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No ............. Date ............................... THIS CERTIFIES that the building located at ~ ............................ 5D DE1 ~ ~, ~1 t~ L~-treet Map No. '~"~/~[" Block No. -- .Lot No. ~) conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. :..., 19 .... pursuant to which Building Permit No. ~: .~.Z.~. ~-- dated ....................... ~ ~A A-. , 19.~f. ~ was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is /e~ 0 N/:- [:k~ c'~ / l_ ?' ~ ~,l/1~ L k / ~ ~ The certificate is issued to ~ ~ ~ ~ N ~ ~2 ~ ~ Y~;' ~ ~ /: ~ (owner, le~e~ o;' ';c..~,.,/-- ' ' of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. N 3 ~J ~ B HOUSE NUMBER. ~0 "~E L ~ t~'k~ ~1~ ............ Street ................................................. Building Inspector FOI~ NO. ~ 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) N? 5738 Z Permission is hereby granted to: ...... ..... ~d~l~ ..C~u~t ~,. · ~a~l ............................ ............. i~e.;].~tm ....... ~,~.~ ................................... to ...... ~tt~,'],~[' "~1~"~I" ':~l~,~]~r "d111U q':[~[I .............................................................................. at premises located at ....... ~t~..l~;).t.....{~&~3~e.~..~l~..~,lr~&,~lll .......................................... ............................................. ~/.~.. ~ e3J~,~..~r&~e ............ .:bl~l~Z....,ll,.~, ................................... pursua:n¢ to application doted .......................... ~&:~e~ .......& ........... . 19.~,.., and approved by the Building Inspector. Fee $.......~.,.'"1.0 ...... FOILM NO. 6 TOWN OF SOUTHOLD 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 triplicate to the Building Inspector with the following; for new buildings or new use: I. 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. New Building ...... lr ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....... ~./.~..~.l..m..~.~....~...~J/..~..e.!...~..~....e.~.:..~..e?...~.o.?..~.. ........................................................ Owner Or Owners Of Property ................ ..~...~...~..~.e...~.~.qf~ ......................................................................... Subdivision ..... l.~m'.~J,..IJ.~ll~/r,.~...~al.~.'~ .............. Lot No ...... ..~,.... Block No ............. House No ............ {~) Permit No..~5.7~.~.~ ......... Date Of Permit ...~.9~.~....Applicont ....... ~/~J~T~..J~Imll~.,...l[~ ......................... Health Dept. Approval ....... ~...?..~,~Le.i~..,1,~?.~ ...... Labor Dept. Approval .......................... ~. ..................... 972 p Underwriters Approval ............................................. lanning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Z ~- ~ 7 ~ ~/ Fee Submitted $ .......5,QQ .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~IT. AI~D H0~, ~l~C./Robert E. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County H.D.Reference No.-) EASTE~ DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPR(~¢AL TO CONSTRUCT PR~ATE S~AGE DIS~SAL SYSTE~ Approval to const~ct said systems is requested~pertinent d~t~ here~th: D~te ~Z~ Address ~¢ X-~¢,O 7-Sec%ion / / 2-Detailed property location ~ /~ ~ ,.~L~ ~8-Lot No. Hamlet ~ ~' ~ ~ / TO~ ~4~ 9-Private well? 3-~blic ~ter supply name Distance to nearest ~in 4-Lot Size: Width//~ ft. Length ~ ft. (also enter on center plot plan below:) 5-~elling: Single Family ~ Two Family? ~ ~Cellar? ~lab? ~ yCrawl S~ce? 10-Pressed system: Septic ~nk ~ ~Precast ~ ~Cess~ols ~YS~llow ~ols ~ /Other / il-Septic ta~ inside dimensions: Vol~e Gals. Length ft. Width f~. Liquid depth 12-Precast sections: ~ ~Number/ ~Sq~re Ft. Cesspools: Block size~ ~ncs. D ~ ~s.H ~ns. Total blocks below inlet: ~1~2~-$~3 ~T PLAN Capacity ~_~_~ Gals. G.P.M. ~"' .~ra~ea ~ , , , -5 ~o~ 0 ~ +~ Rte th Data eet 0 2 4 6 8 10 12 16 t8 ~ ~o, ~ Street ~ ~ ~ ~ = Indi The Undersign~ CERTIF~S: "Const~ction of authorized installations ~11 be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, a~ amendments thereto, covering Private $e~ge Dis~sal Systems". ~er or Builder FOR F~ALTH 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 can be installed on this Plot. ~ I0./65 Revis.) Signed S-9 SCHD SUFFOLK COUNTY TO WHOM IT MAY CONCERN: The sewage disposal at DEPARTMENT OF HEALTH Date 7 August 1972 Bldg. Permit No. 57~RZ facilities for a structure located Lot #40, Laurel Oountry Estates (Give deed location) E/S De~m.r Drive, N Laurel, NY have been inspected by this department and found to be satisfactory. AUG 9 1972 Chief of General Engineering Services Gl Lot ~9 40 41 Lot .=WS~ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: · $. P.A. ~IVT~RPt?I$£$, INC. 107' NO. 40, "IAUR£1 COUN7'BY ~_~TAT~S.# town oF SOUTHOLD N Y ay SU~FO,K co., TITLE NO. $-$G0~80 Lot · = MONUmEN~ SUBOIVI$10# IIAP FILED IN O~ rUE CLE#K OF SUFFOLK COU#I"Y JUNE ~, 1~70 AS ~MP NO. REVISIONS YOUNG & YOUNG .4/~/9~..~,1.~"~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ~A~'/t/'~2"~ ALDEN W. YOUNG HOWARD W. YOUNG UU~EI~r 1~2 PROFE~IlONAL ENGINEER AND LAND ~URVEYOR ~;~r SURV[Y FOE: LOt *o ~o, "L~u~t cou. r~r ~r~r~s." ~ LAUREL ~u~.~.~ ~o~ TOW. O; SOUTNOLD SUFF0~ co., ,. Y.~__~ BUILDING DEPARTMENT SOUTHOLD, N. Y, ~ ° Disapproved a/c .~..~~~~4~_~~ InsPector. b. Plot plan show ng location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th s appl cat on/ 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 progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~-~ hall have been granted by the Building Inspector. .,/v APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to me ~uildJng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or (egulations, for the construction of buildings, additions or alterations, or..for removal or demolition, as herein described. Fha applicant agrees to comply with all applicable laws, ordi nantes, building code, housing code, and regulations. Inland H ~ .m. e ..s. x ,,, .I..n...c..,.~.~ .......................... (Signature of applicant, or name, ifa corporation) Selden, New York (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................ : .~.~ ~. ~'.~...~..9.~ ~'~ ~ .t,.~ ~ .............................................................................. Name of owner of premises ............................ ~]~...~'3.~.~.TM ..................................................................................... Ifapplicant is a corporate, signature of duly authorized officer. '7'-//- Robert Hiltz .................. ' ......... ; I ]. Location of land on which proposed work will be done. ~op No..~,.~,,u...~.,e,,,1,,.,C,..°,,u.,,~,~',,,,,~,~,'~Lot No ........ ,~,0,, ............ ..... E/S of Delmar Lane. Laurel ~treet Gna iNumDer .................z ......................................... ~'. ....................................................................... ~ ~' 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................. Intended use and occupancy 1 Family Dwellin~ 10. 11. 13. Nature of work (check which applicable): New Building ...... X. ......... Addition .................. Alteration .................. Repair .................. Removal ................. , Demolitiac .................. Other Work (Describe) ........................................ ~2o,ooo - ..~Z'.~: Estimated Cost ............................................................ F,, ....., ....................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ......... ~, ................ Number of dwelling units on each floor ...... .6.. ................... If garage, number of cars . . lb~ X 20 If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .......................................................................................................... ] ...... Dimensions of same structure with alterations or additions: Front ~.c~.!...~..". ..................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front ....... ~.~.!....~..~.~. .............. Rear ..~.9~ .8." . D--tL 26 Height 18 Number of Stories Size of lot: Front ~,.~.~.)Z!! .............. Rear .......... .[..~..:..~ ........... Depth ....~.c?.~.'..7..8.. ............. Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation~ 1~o Name of Owner of premises ..~]~.~,..~:O,.~.~?.:~.li.q.~...Address ........ .,,]~..~t. tc..t..~.u...c..~.. ............. Phone No ..................... Name of Architect ....[.~...~..~.~g....~..o...m..e.~...~..~..o...~. ........ :Address ......... .S..e...~..~..e...~. ..................... Phone No. 732-2177 Name of Contractor ..~D,],l~l..~.qxqf~.~...]:.~..c.., .......... Address ......... ..S~....1...d.,e?. .................... phone No. 732-2177 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property line.s. Give street and block number or description according to deed, and show street names and indicate whether inter~or or comer lot /.z s4. ,/~z L I STATE OF N L:W ~RI~..~ t S S .............. ,,: ..... ./,,x~../.~r.....: ...... /.'~:-D ......... being d-,~y ,,a.'r,, d~o,s and say, th,,t he ~s the applicon, obove 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 contoined in this application are true to the best of his knowledge and belief; and thar the work will be performed in the manner set forth in the application filed therewith. Swom to before me this · - ..~ -- // / NOTARy pIJ ~ ~. ILLE ~ No 52.$~25~ n - -- W Yortt ~errn £Xpires March 30, S.P.A., Delmar Drive, Laurel, L.I. Job ~!50 -- T ..... I I I I 1 / 1 I I I / I 11 I . t J / I I ' '- I ~ ..... .~.~,. ~ .... 1--1/8 bp, i-1/~2 bp. , , ~ , , ~t,,n,,ceo. feeder/S. 2-3ff8, z-2~12. ~F~tu~e appliance Ill:O" .C '0 ~8 17;'0" ' I'o: