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Home My WebLink About6327-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at 1~/.~ .l)e~la~'. D;~.Ve ......... Street Map N~.e~. ~, Block No ........... Lot No. ~ ........ ~l. ·. ~,Y, ........ conforms substantially to the Application for BuildMg Permit heretofore filed in this office dated ............ J~... 5.., 19 .?~. pursuant to which Building Permit NO. ~.~2~.. dated ............ ~aB... ~..., 197~.., was issued, ~d conforms to all of the require- ments of the applicable pro~sions of the law. The occupancy for which this certificate is issued is . ~. 0V0..~m$~ .~g ....................................... The certificate is issued to . I~. ~S..~n0 ........ ~ ....................... (owner, lessee or tenant) of the ~ores~d bulldog. Suffolk Cowry Department of Health Approval .~X.. ~ 7..~.~...~. ~ .V~* ..... UNDERWRITERS CERTIFICATE No .... ]. ~7.7~5.. ~r. e..~.975 ........................ HOUSE NUMBER. ~090 ....... Street... D.~..~$Y9. ............................... FOBM NO. ~g TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6327 Z Permission is hereby granted to: ......... It~lc~l~..Ceu~tr.~..lioad ......................... to .~u~..~e~..o~e...l;a~$.l-y..et~e~,~g .................................................................................... at premises located at ...Z~xt...~ls...../~au~e~..~eu~t~-.r..~,s.ta~e~ ............................................. ........................ J3~aLma~.. J)~.t,~e .......... I~urel.......~.,,¥, ................................................................. pursuant to application dated .......................... ~n .......'~ ............. , 19..~.., and approved by the Building Inspector. F~ Se~.,.et 0 ............ --Bui ding Inspector( FORM NO. S TOWN OF SOUTNOLD Building Deportment 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: 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, 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .......... .2. · .]: .. ,Ma..Y,....1..?, .?,..5. ........... New Building ...... ~ ........Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...............~..~..,D~.~..,~;~.~.~.e ............................................................................... Owner Or Owners Of Property ....................... ~...~...d.....~...o..~..e..~...~.~.q... ..................................................... Subdivision ..../~....u..r...e.~.....C~....~..n..~.r.~.....~..~..&.~..e.~ ......... Lot No ..... ..3..1.... Block No ............. House No ............. Permit No....6..3. 2.~..~. ...... Date Of Permit ...]./..4./.?'...3.....Applicant ......... .~.D..].~.~. ~..~/g.~.~.~....~D.g.~ ............... Health Dept. Approval .....S..O...-.~.2...6.?.....5./.~?./.7...3.....Labor Dept. Approval ................................................ Underwriters Approval ...N..8..?..7...2..5.....5..../..2.../.Z~. ........... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........ .Y...e..s. .......................... Fee Submitted $ ......~..~.Q.O. ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant....~.. ~..~.....'~....u:..z'. ~ .e..r.. ,......V~.. ................. Sworn to before me this ~ .... ~, -,-~ ~ _ . ,~,4~ ~ (stamp or seal) ~RY PUBLIC, State of New York 52-8841]00, Suffolk County ,erin Ex~ires March 30, SUFFOLK COUNTY DEPARTHENT OF HEALTH HoDoReference No ~ O-/~7 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date 1-Applicant ~1~ ~ ~-- p~on. ?~_______~6-Sub div ~1 ~. ~a Address ~__ ~e 7-Section 2-Detail~ p~pe~y location ~$ ~ ~X~ 8-Lot No. $~ Hamlet ~ To~ ~ 9-Private well? ~ 3-~blic ~ter ~p~me ___ Distance to nearest ~in 4-Lot Size: Width ft. Length mos ft. (also enter on center plot plan below:) 5-~elling: Singl~ Family ~ T~ Family? ~ YCellar? ~Slab? ~ ~Crawl S~ce? ~ ~ 10-Pro~s~ syst~. Septic tank ~ fPrecas~Cess~ols ~yS~llow ~ols Y YOther ~ il-Septic ~ i~Ide dimensions. Vol~e~Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~y ~Number/~Sq~ Ft. Cesspools: Block size~" incs.D ins. H ins. Total blocks below inlet: ~1__~2__~3 ~T P~N Capacity45 Gals. Street Data Peet 0 2 6 8 10 12 18 ~ H "~ Ind~ ate ~c~ Nc th 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 ~2~72 Signed ~ $~ ~,~e ~ 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 ~ ~ Signed (10/65 Revis.) S-15 THE NEW YORK BOARD OF FIRE UNDERWRITERS - bk BUREAU OF ELECTRICI'I~' 85 JOHN STREET, NEW YORK, NEW YORK 10038 .,.re .a,' 2, 1973 631"1" ,,."' 87725 S CERTIFIES THAT the electrical equipment o~ described below and introduced by the applicant named on the above application number in the premises of Inland Homes, e/s Delmar Dr., Laurel, N,Y, Job 176 ~,efolto.~ing location; ~ Basement [] ~.,ninedon April 30, 1973 100 CB , ors. 1-1 hps [] 2nd FI. outside Section Block and found to be in compliance with the requirements of this Board. UNIT HEATERS MULTI-OUTLET SYSTEMS ' ' NO. OF FEET C OF Hi-LEG JOE 31 EXHAUST FANS DIMMERS E 4 Park Place . rfificate must not be altered in any nlanner; retuln fo Ihe office of the Board if incorrect, Inspectors may be iffentified by their credentials. The sewage disposal and water supply facilities for this location have been Lot ~0 Chief of General Engineering Services EDUCATION LA'k/. IlO T£ : · = MO~tYENr ., Lot ~' '~ \' DIETZGEN 135 11846 REVISIONS YOUNG & YOUNG dAN. 24,19*75 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK MAY I, 1973 ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOE: INLAND HOMES,INC. LOT NO..'51 ~' LAUREL COUNTRY~ 'Y L A U R E L ~ [~ ~OL~_~A .~ YOWN O~ SOUTHOLD SUFFOLK CO., N.Y. SCALE: I" = 40' ~ ~ ~ TUTION, GUARANTEES A~L NOT T~ANSFE~ J~ REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: INLAND HOMES, INC. LOT NO. ;51 ~' LAUREL COUNTRY E~? LA U RE L j G, ~ AT ..11 'TO'WN OF $OUTHOLD Lot \' DIETZGEN 13S 1184~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ SOUTHOLD, N. y.~ , xom,r, ..... ........... , .................... ............ s pprove o/c .......... APPLICATION FOR BUILDING PERMIT . ~,~:~ Date , 3 Januozy ~0 73 ~ INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict pl~fl showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, anc~ giving a detailed description of layout of property must be drawn on diagram which is pert of this applicIKion. c. The wink covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or~ in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION I$ HfiBfiB¥ MADF to the Building Department for the issuan~ o~ a Building Permit pursuant to tbe Building Ordinanca of the Town of 8outhold, Suffolk CounW, N~t York, and other applimble I..~ Ordlnanccs or B~ulafioos, ~or tbe con,ruction buildings, ~dditions or alterations, or for ramoval or demolition, as harein described. Tha applicant agrees to comply with all applicabla ordinanccs, building code, housing code, and regulations, and to admit authori~ad inspectors on promises and in tmi~dings for r~_~___t_~ry in~l~'tions. Thuzbe~ ..... .................... (Signature of applicant, or name, if a corporation)~"~ .... ....................... (Address of applicant) i~U State whether applicant is owner, lessee, agent, amhitect, engineer, general ,contractor, electriciari, plumber or builder. ............................... ' ' ~.~e~:a~. Contza~to= · Name of o~ne;"0f [;;~;~' .............................. ~L"c~'"~'"'";~' ................. ~'""~ ........................................ If applicant is a corporate, signature of duly authorized officer. ~ ~""~/..,f "~ t ................. ~.~...~...~.,...~.~ ,....~.. .............................. (Name and title of corporate officer) ~'~(' ~./~ ~t. ~ ~ .,~ (I '~ 1. Location of land on which proposed work will be done. Map No,: .................... Lot No ........ .,~.3,.,3,. .............................. Street and Number ........................ ~/~S~.~D~D~/~v~e~t~e~c~~t~*~1;~e~s~a~;~9~[ .............. ,, Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy .................. .1.....~.~......D~...e...1..1.,iag .............................................. 3. Nature of work (check Which applicable): New Building ..... .~....e~.. ........... Addition ..................... Alteration ........... ,... Repair ......................... Removal ......................... Demoli~tion ........................ Other Work .................................... {Description) 4. Estimated r~e* 920s 000o 00 Fee (to be paid on filing this application) 5. If dwelling, number of dweliing units ...... .1....: ..... Number of dwelling units on each flOOr ......................................... If garage, num .... ca .................................................. ; ........................ 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 alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ . . 26 8. Dimensions of entire new construction: Front . .. .5. ..9. ~.8. . .". .......... Rear .....~.~....~ .............. Depth ................................. Height 3.8 1 ..................................... Number of Stories 9. Size of lot: Front ..... :....1..3...8...*...0~....~. ............. Rear ........... ~.~.~a.QQ.! ............... ~-+~ 157,28 t Height ....................................... . ............ Number of Stories ...................................................................................... Date of Purchase ..................................... Name of Former Owner ............................................................................ 10. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~.q. .......................................... 13. Will lot be req~aded .................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of prcmises ......... .~...../...a..1..a~...d.....~.~.~.....Z..a..c..o,.....:. ....................................................................... (Address) (Phone No.) · ..... Name of Architect ...................................... · .......... .~ ................... ~..~Z ........................................ (Address) (Phone No.) ~ ~ ZI~C. 732-2177 Name of Contractor .................................... ~. ........... .~ .................. .....~,..~ ...................................................... (Address) (Phone No.) PLOT DIAGRAM · , -... Locate clearry and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from "pr~O~ li~es~-Giv~' stmet~hCi'block nd*ml~r'or description according to deed, and show street names and indicate wheth- er interior or c lot. ne! STATE OF NEW YORK,~ ) COUNTY OF .......... ~. ............ ) .......................................................................................................... being duly swo[n, deposes and says that he is the applicant 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 end to make and file this application; that all statements conteined in this application are true to the past of his knowledge and belief; and that t~L~$~MI~ performed in the manner set forth in the application filed therewith. ..: * . : · '. : . NOTARY PUBUC, Stats of New Yorl~ J --I