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Home My WebLink About6328-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificsle Of Occupsncy No.. Z..5X79 .... Date ..............~.~l~...]. ...... , 19..~ THIS CERTITIES that the building located at . .ld/~ nelmz~ .DI'I.~® ....... Street Map No. ~ .C~No ........... Lot No..~6 ....... ~..~ ~... ........ conforms substantially to the Application for Building Permit heretofore filed in ~is Office dated ............ ~...~ .., 19. ~3 pursuant to which Bufld~g Permit No.. dated ............... ~..~., 19.~., was issued, and conforms to all of the require- ments of the applicable pro~io~ of the law. The occupancy for which this certificate is issued is . .~e~e. ~. E~Y. ~.K ...................................... The certificate is ~sued to . ~ .~a. ~, .... ~g~ ........................ (owner, lessee or ten~t) of the afores~d building. Suffolk Co~ty Department of He~th A~proval ~.. ~..]~7~..~Y .~. Y~ ...... UNDERWRITERS CERTIFICATE No...~. ~6...~...~,. ~ ...................... HOUSE NUMBER.. ~2~ ...... Street .....DO.~. ~Y9 .............................. ~-' Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPA~.TMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6328 Z Permission is hereby granted to: ..... .~..~.~.......z.~ .................................... ....... .... $.~t~e...gmtr~.llea~t .......................... ~e3~en ~.~. 11 8i~ - - ~ at premises located at ....... ..~...~,...~J~l...../~gl~,...~l~Z~.~dl~ll~ ............................................ ........................................ ..v..e.~..~r~ .......... ~u~r~ ....... ~.~. .................................................. pursuant to application dated ................................................. 19...~.~., and approved by the Build'rog Inspector. Fee $...~.] J..'LQ ......... Building Inspector FO~tM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Offico 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 alt 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 $5.00 3. Copy of certificate of occupancy $1.00 Date .., ~.....~.. ~.....3:. ~..7..3, ..................... New Building ..~ ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property Lot #26, W/$ Delmar Drives Laurel Country ~st,, Laurels Owner Or Owners Of Property ......... .I.~....~,...~..,..~.I.....,~....C..'. ................................................................... Subdivision .l¢.~..q.r...~.~..,,C.°.R.~.A~......~...}~?. ........... Lot No....~...~. ..... Block No ............. House No ............. Permit No....6..~]..8....~...,. Date Of Permit ..~.Z.~.ZZ.3.....Applicant ..~,D....~.?...,~.?.:. ..................... SO- 1266 12-21-72 . Health Dept. Approval ........................................... .~-avor Dept. Approval ................................................ Underwriters Approval ..... ~...~.7..7.~.(~......~..r.~..r.~.~..,.. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ..5..:..0...0. ......................... mayo Construction on above described building and permit meets all applicable codes and regulations. Applicant ~~~..h.. ~ :...,, .T~.,. ,u..r..b,, .e. ,r,. ,~.....V. :..P.,: Sworn to before me this ....... ~ ~ ~ (stamp or seal) NOTARy PUBLIC, State ol N~w York "~ ~o. 52-884]100, Suffolk Col,n~y T~m [~p/res Uarch 30, 197 ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~1~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant X~ ~f ~1C:, Phone?~-~6-Sub div~e~ Address ~-~. ~.. ~1;~' ~d.___~e~e~_ .7-Section 2-DetailE property~location W/$ ~ ~V$ 8-Lot No. Hamlet ;~$~ ~ Town $~ .9-Private well? 3-Public water supply name Distance to nearest main 4-Lot Size: Width_~l~ft. Length ~t. (also enter on center plot plan below:) 5-Dwelling: Single Family ~ ~ Two Family? ~ ~ Cellar? ~y~ Slab? ~ ~ Crawl Space? 10-Proposed system: Septic tank ~ ~Precast ~ /Cesspools ~Shallow pools il-Septic tank inside dimensions: ~olume ~O~als.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~_~Number~_~Square Ft. Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet: #1 ~2 ~3 PLOT PLAN GW.L. I I Capacity42 Gals. ate 'th Data Feet 0 2 6 8 10 12 14 ~6 18 ~ ~ ~= Street ~ ~ive mo~ ~ ~ Indi ~ ~ No The Undersign~ CERTIF~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s~ Bulletins, a~ amendments thereto, covering Private Se~e Disposal Systems". Date ~;~ Signed ~ ~, ~,~e ~ or Builder ~ .~3 ~ / ~ FOR ~ALTH DEPART~NT USE ONLY. Based on the info~ation presented herewith, it is the opinion of the Health De~ment, that an adequate and satisfacto~ Se~ge Dis~sal System can be installed on this ~ot. Date / ~_~ ._ Sign~ ~' ~~ ~ ~ 10/65 Revis.) SUFFOLK COUN2Y HEALTH DEPARTMENT MAY 2 ~ Ig73 ~. o. ~. The sewage disposal and ~ater supply faeili,+Jes for this location have been inspected by this department ~nd ound %o be satisfactory. Chief 0f General Engineering S~v~es UNAUTHORIZED ALTERATION OR ADOIT$~ mUCAT*O~ LAW. ,s~,.~.~.., ~,~.,~, ~,,~ REV,S,ONS YOUNG & YOUNG dAN. 24, 1975 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK MAY I, 1975 ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: INLAND HOMES, INC. .~. LOT N0.26," LAUREL COUNTRY /~?;~"!~' AT L A UR E L s~ I~DLD sm ~kTY ~:~A~r0. TOWN o~ SOUTHOLD ~ DIETZGEN 135 1[846 2'7 ;iNA · -' M(~/UMENT $~OI¥1$10NM/tP FILED I# THE OFFICE OF THE ~L Et?I( OF SUPFOU( ~OUNTY ON dUNE RR~ I~?0 ~$/=7/ EI~, ~4~& REVISIONS YOUNG & YOUNG 400 0$TRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND LAND SURVEYOR SURVEY FOR: INLAND HOMES, INC. LOT N0.26," LAUREL COUNTRY~S'~ TOw.'T o, LAUREL SOUTHOLD SCALE: I": 40' IDATE: DIETZGEN 135 11846 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ __ TOWN CLERK'S OFFIC~ ~UTHOLD ~ v ~ ~m~ ~ ..... ~ ...................... L..., I~...(... ~ ~.,~.- ................. ........ .............. APPLICATION FOR BUILDING FERMIT Do~. ................ A~ ........... ,19ZA ....... INSTRUCTIONS a. This application mus~ ~ completely filled in by tV~wri~er or ~ ink a~d submitted in tripli~te to ~he Building Inspe~or, wi~ 3 sets of pl~ns, a~urate plot plan to scale. Fee 8ccording to schedule. b. Plot plan ~owing location of lot and of buildings on premises, re ationship ~o adjoining pram ses or public s~ or areas, giving a detailed description of layout of pro~rtV mus~ be drawn on diagram ~hich is c. The work covered bY this application may not be commen~d before i~uan~ of Building permit. p d. o~n approval of this application, ~he Building Ins~ctor will issue a Building Permit to ~he applicanL Such ~rmit,shell ~ kept on the premiss ~vailable for ins~ction throughout the work. e. No building shall ~ occupie~ or u~d in whole or in part for any purpo~ whatever until gr~n~ by the Building Ins~ctor. APPLICATION IS H EfiEBY MADE to the Building oepa~ment for the issuan~ of a Building Permit pu~uam m the Building Z~ Ordinen~ of the Town of ~uthold, Suffolk CountY, New York, and other applicable Laws, Ordinaries or fiegulafions, for t~ ~nstru~ion of buildings, additions or alterations, or for removal or demolition, as herein descried. The aDplican~ agrees to comply with all applicable l~ws. ordi nan.s, building ~de, housing code, and regulations, and m admi~ authorized ins~ctors on premiss and in buildings for ne~s~ ins~ions. state whether applicant is owner, le= INLAND HC~"~.S, INC./K.W. Thurber Selden, New York 11784 (Address of applicant) :e, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... .~ r~.. ~ ~...(;.9.~.,~.q.~.~.. ................................................................. Name of owner of premises Inland H~es, Inc. If applicant is a corporate, signature of duly authorized officer. ............... ~...~ :... ~.h...~....b..e.~ ,..._V.~.. ............................................. ~Narne and title of corporate officer) Builder/s License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ..... ..2,..6.. ............ Street and Number u ................................ ~/~S~D~D~r~v~e~-~u~e~C~t~r~ ..l;.~R.q.~ ...................... . 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 ...............................l.....F....a~..~.~......D~...e...~.~..~..n.g ............................................................ Nature of work (check which apolicable): New Building ......~...e~... ...........Addition ..................... Alteration ............... Repair ...... Removal ............. Demolition ........................ Other Work .................................... ............................... (Description) · ~20 ~ OOO. OO Fee (to be paid on filing this application) 4. Estimated Cost ................................................................................................................................................ 5. If dwelling, number of dwelling units ....... ..1. ....... Number of dwelling units on each floor ......................................... 14 X 20 If garage, number of cars ............................................................................................................................................ 5. If business, commercial or mixed occuoancy, 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 addition~: FrOnt .......................... Rear ......................................... Depth ............................................. Height ....................... ; ...... , .......... Number of Stories ........................................ 59' 8" '59' 8" 26 ' 8. Dimensions of entire new construction: Front, ........................ Rear ............................ Depth ................................. Height.......... ....18....'.........- ...... ... _... Number of Stories ............ .1. ........................................................................... 130 o OO ' Rear l 3,.O.......O~.. '.. . Depth 190. OO ' 9. Size of lot: Front .................................................................................................................. 10. Date of Purchase.... ............... .... .... .... ...... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated .................................... or regulation: ............................................................ 12. Does proposed construction violate any zoning law, ordinance no 13. Will lot be regraded ..............................Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises In~...a~...d.....H....o~...e...s.~...:[.n..c..~. ................................................... ....................... (Address) (Phone No.) Name of Architect .........~...H.~&...~.~].~.~. ................... ~]~:]~...l[i~a...][~(. ....................... ~=~.~.7. ............. (Address) (Phone No.) Name of Contractor ...... ~....H.~.~...~.~.~ .................... ~..I~[..&..A'~t~' ........................ 7...~.~..-.~.[7..'~. ............. (Address) (Phone No.) PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK,~ //~,~ ) COUNTY OF ........... ../,~. ~ ............ ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the (~o111;ra.¢1:o.~ ........................................................................... (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 DOLORES SCHOUB$ set forth in the application filed therewith. NOTARY PUBLIC, State of new Yorl( ,~'3~'~, ' ' No, 5,,~-884,t. i00, S~folk ............... ...~...,~. ........ day of .................. .... 19 ..2.'~.. .... / (,.~~a-~,~}.~;~County Notary Public ........... Cou ........ (Signature o/applicant} 21.0 '1