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Home My WebLink About6365-zFOB, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z~t~3~. ..... Date ............... Sep.i; · · 10 ..., 19. THIS CERTIFIES that the building located at . .Laurelwood .Dr. &H. eathex, ........ SPtrleet Map No. Lau~elwood Block No ........... Lot No .... l0 ....Laud. el.. I~ o¥, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J&n' "17' '" 19'73' pursuant to which Building Permit No..-636~ dated ............ Feb... 8..., 19. ?3, was issued, and conforms to all of the require- ~.~. ments of the applicable provisions of the law. The occupancy for which this certificate is ~'--~i..s,~ued is .. Pr. irate, one..fam~l,ly, d~'elllng. ..................................... The certificate is issued to ... Jolm. ¢.rol~s~ey. · of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) UNDERWRITERS CERTIFICATE No... !~. 0~ ·...I~ue. · .~. ] 97] .............. HOUSE NUMBER ... 1 ~ ...... Street .. -Laul~lwood .Dx-i'e® .................... ..... ........... Buildin~-~nspecto~ FORM 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? 6365 Permission is hereby granted to: ................... ~.alle~ozt. t, ...... ~i.Z. ...................... to ~.. zm,,..~ae..faat~...d~mL~.~ ..................................................................................... at premises located at ...... .T~3t...~.(~ ...... ~~..~t~ .................................................... ........................................ Lau~e.l.vcmd,. 3)at ............. ~a~,et.....l~,,~.,, ............................................. pursuant to application dated ..................... .~.1~. .......... ~-~. ............ , 197,~..., and approved by the Building Inspector. Fee $~...(~...t...~... ......... Budding Inspecto/"1 FORM NO. 6 TOWN OF SOUTHOLD Building Depo~tmeat 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, o 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. C. Fees: I. 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 D te ........... 9.. ...................... ....... New Building ..... .~. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Lo, arian Of Property ............. Owner Or Owners Of Property ..~(:?..~..,,,~....~:....~,~.~.~,~,.~. Subdivision ...tc~..~..~,..~....~....~...~..Q.~...r~. ........................ Lot No...~..C)..... Block No ............. House No ............. Permit No....(-~....~...~... Date Of Permit~..~.b ............. Applicant ..~.....~.......~..: ....................... '~ ................ Health Dept. Approval ....... ~;~......~/. ........................ Labor Dept. Approval ...... .~,.. ............................ ......... Underwriters Approval ~...0.~....~..~..?] ...................... Planning Board Approval .....~....:.!...~... ...................... Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .. ,~......c~.... .................... Construction on above describedApplbUildingican~anj;I,-germit meets,,,~l ............ applicable~.~.~codes and regulations. ........ Sworn to before me this Notary Public .................................... County (stamp or seal) /~. ~._~..~_,)~,.. SUFFOLK COUNTY DEPARTHENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,perti~.ent data herewith: Date 1-Applica~.A_ .~,_._~_~ ~ ~.~.. ~..~..~ ~hon~. ~ ~ SuB di~_~. ~ ~ Address~ ~_ ~,,, ~' . -~ ~ ~ ,,,,~'~, ~.~. 7-Section ~ 2-Detaile~ proper%~ loca~mon ~'$ ~.~..~-~,~j~-~,7, -)*. ~< A ~%t No, % (~ Hamlet L~.. ~-- ~ To~..~ ~ 92P~vate well? ,~ 3-~blic ~t~-Sdp~me ..... ~ -- ~ DistJnce to nearest ~in ~ 4-~t Size~ Widt~ft. LeftiSt. (also enter on center plot plan below:) lO-~o~s~ system. Septic tank ~Pre~s~ess~ols ~ YShallow ~ols Y yOther ~ il-Septic ~ inside dimensions. ~ol~s.Length ft. Width f~. Liquid depth ft. 12-~ecast sections: ~yNumber~Sq~ Cesspools: Block sizeL zncs.D ~s.~ns. Total blocks below in~t: ~1 ~2 ~3 ~T P~N Capacity ',___~als. Street Indi e No ~th T~st H~ Data ~eet 0 2 6 8 10 12 ~6 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems'%. Date~' ~ Signed~ Owner or Builder FOR HEALTH 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. Date (10/65 aevi..) S-15 Signed TOWN OF, BUILDING DE.P,A. RTMENT TOWN C~RKS ~UTH~D, ............................. , . . * Dimpproved a/c .................................................................. ............................... (Building APPLICATION FOR BUILDING PERMIT ~' Date .....'~r.l~,,~ ....................... o 19~.........~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspe 3 sets of plans, accurate plot plan to scale. Fee according to schedule. . b. Plot plan showing location of lot and of buildings on premise~,.relationship to adjoining premises or public streets or giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 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 shell have been granted by the Building Inspector. . _.~ T~_~APPL~CATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the BuJlding~ox Or~'mance:. ~ the Town of Southold, Suffolk County, New .York, and other applicable Laws, Ordinances or Regulations, for the cone'efuetfi~'t df buddings; ~dditions or alterations, or for re, moval or demolition, as herein described. The applicant agrees to comply with all Ii~l~lie~ble I~w~, ordinances, building code, housing code, and regulations, and to admit author[zed inspectors on premises and in buildings for neceff~r~ inspections. G~.el~ l~e we:l. dtmim~ & ~e Zee. (Signature of ~,pplicant, or name, if e corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · eneriaX geu~z, aet;er Name of owner of premises .......... ..~...~q....,T..q~I~....R..q....~.~.9..s. AI],~. ............................................................................. . ......... -/ '~ (Name and titre of corporate officer) ' LaUA~Xweod E~tat;ea ~0 1. Location of land on which proposed work will bedone. Map No.: ..................................................... Lot No ............. Street and Number Lauz, eXvood D~ive ............... ....................... ...... .......... .......... 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: Existin use an- WOOdOd A~oa a. g a occupancy ........ ~.ll~i&' ............................................................................................................. b. Intended use and occupancy ....................... ~lt;J~..~J~.~lJ,~ ................ ; ...................................................... ~ 3. Nature of wore (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Rea)oval ................... .....; Demolition ........................ Other Work .................................... , ~k,~,~ ~ ~ ' ~'**/'~0 ~ ~ (Description) (to ~ ~aid on filing this appli~tion) 5. If d~lling, numar of d~lli~g- units ........ ~.**...~ Num~ of ~lling uni~ on e~h floor ........... ~. ........................... If ~r~, numar of cars ..........1 ............................................................................................................................... 6. If busine~, commemial or mix~ ~upanw, s~ci~ nature and extent of each W~ of u~ ..................................... 7. Dimensions of exi~ing ~ruc~?~tif any: Front ..................... Rear ........................... Depth ................................... Height ................. , ........................................ Numar of Stories ............................................................................. Dimensions of ~me structure with al~rations or additions: Fm~t ...... , .................. Rear ......................................... Depth ............................................. Height ......................................... Numar of Stories ........................................ 8. Dimensions of entire new construction: Fret ....... ~f.~E. .....Rear ....~ ............ Depth .......... ~ ........... Height ................................................. Numar of Stories ................................. 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. ~teof < ~ '~:~ Purcha~ ..................................... Name of Eormer Owner '""~"~"1~"~ ....................... 11. Zone or u~ di~rict in which premiss am si~at~ ..................................................................................................... 12. D~s propomd construction violate any zoning law, ordinance or m~tation: ............................................................ 13. Willlot~reCaded ................................... Willexce~fill~mmo~dfrompremi~s: [ ] Yes [~ No ..... a. ............................... 14. Name m uwner o~ prem~ .................................................................................................... /~ ~ (Address) (Phone No.) Name of Archit~t ...... , ......................................................................................................... v...~ ............... . Name of ~ntra~or ~ ~e ~.~d~s · (Address) (Phone No.) PLOT DIAG RAM ?~;'~~. L~ clearly and di~i~tly all building, wh~er exi~ing or propo~, and ]~i~ all ~t~ ~mons from pr~ li~s. Gi~ ~met and bilk number or de~iption ~cording to deed, and show ~reet nam~ a~*~ whe~- er in,riot or corner lot STATE OF NEW YOR~I~~ i S~. COUNT~OF ............. ~.3~~.~//~- ~ .......... ..................................... ~.....~..~being c1~1¥ s_worn, ,~, and ,ys that he is the appli~nt abo, na~d. He is the . ~ ...... ~ -- ( ~nt~tor, ~h coyote o~r, etc./ of said owner or owners, and is duly authorized to ~dorm or have ~dg~d th[s~ork and to make and file this ap~li~tion; ~at all statemen~ contained in this application are true to t~ ~st of his knowled~ and,~li~and that ~he work will ~ ~or~ ~t forth in the application filed t~mwith. ~ _ ~ ~ ,o,r,,u, ...................................................................... ..... (~ of ~pu~O /0 HEALTH DEPARTL~NT I . I I