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HomeMy WebLinkAbout6627-zFORM NO./4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No...~'~.~8 .... Date .......... 0ctoher. ~.1 ....... , lg. 73. THIS CERTIFIES that the building located at . DeLu~r. ~r~.~r.e ............ Street Map No .... ~8~ .... Block No...iT,~ ...... Lot No.. 23.t ...... L~ur. el ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~m~y. ~.t ......... , 19.~. pursuant to which Building Permit No.. dated ~ .... Jl~e..~ .......... , 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . l~v~ta .one. £~..d~l~ ~:r,g ....................................... The certificate is issued to .. Gc0~.gC. ~.~t~,l,l .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ilatcr] ~ .~OP~,. 2[~.~ 1 ~?~ .by. R~ UNWRWR~RS C~R~C^r£ ~o... 1~ ~atT...Dat~. ~pt,. 9., .19~ ............ HOUSE NUMBER... ~.9.1.i~ ..... Street...]~O]:r~_X'. I)~t. VO ................................ Building Inspector FORM NO. 2 TO~N OF $OUTSOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6627 Z Permission is hereby granted to: ..... ~.~......~.¢.a..Z..e....g.9...ug,..~.~...,~.o..a..¢. ................ .......... ~.~:l.~.~a ......... .~L,.~..-. ..... ! ~.7...~:... ................... to ...~.~J.2,~..~...o,,-n~...~,~,m~.~'...~.~..n.g .................................................................................. at premises located at lot 21 Laurel Cotmt..r~. Estates Delmar Drive Laurel ll.Y pursuant to application dated .... .. ......................... ~..8:~.......~..'J. ......... , 19....?..~., and approved by the Building Inspector. Fee $....6.~ ,0 ~0 ........ Building Inspector/ THE NEW YORK BOARD OF FIRE *UNDERWRITERS BUREAU OF ELECTRICI~ N 113017 THIS CE~IFIE5 THAT in the foHo~ving loc~tion; ~ B~me~ ~ 1st FI. tvasexaminedon I~U~UST, ~) · [] 2.d ri. outside Section Block and found to be in compliance ~vith the requirements of this Board. RANGES COOKING DECKS OVENS DISH WASHERS AMT. K. W. I AMT. K.W. ~AT. K. W. _ TIMECLOCKS BELL UNITHEATBES MULTbOUTLET AM,'. ,,,,,~ T.ANS:~,.,. ~.~,~s~. ~uXTTL~TBES IECEPTACLES SWITCH~.I~ 1~ FIXTURES 16 33 MOTORS FUTURE AP~JANO: Kd!DERS DRY;=RS FURNACE ~ SERVICE DISCONNECT O. OF S R V i C E i ].00 C~ IETER : ' °~Bu'~i~Z~/s: Oil, 1-1/flhp · 1-1/12hp #Future appliance Feeder/s: 1-2~12, Mo$or/s: 1-1/2bp 21 EXHAUST FANS At, AT. H.P. DIMMERS OF NEUTRAL George Z tr~inghau8 4 Park Place Patchogue, L.I. 1177~. COPY FOR.BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 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 duplicate to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate Iocahon of all buildings, property lines, streets, and unusual natural or topographm 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. 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 $5.00 Dote ....... .~ ./../....~ ./...'?..~. ................. · / -- New Building .....X. .............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~/./.5..~)el~a,r..~D;~,.v.~t .......... ~%~,~'.~..~:g.~rl,~;~'....]$.$..l;.~J;.~.~i ............................. ~ner Or ~ners Of Prope~ Inland H~es / Ge Wes~hall Sul~ivision ............ Block No ............. House No ............. ............... , ................................................ uot No, 6/1/73 . . Inland Homes Inc. Pe~m~ No. 6627 ~ Ou~e O~ Pe~m~ .................... ~ppdc~n~ H.o~m Dopt A~ovo~ ~2~.~...m..~.~.~ ..... ~5o~ DOP~. A~2~o7o~ ................................................ NllSOlg ~. . Unde~H~e~s A~o7o~ .............................................. ~m~mn~ 8oo~d A~ovo~ ........................................ Reques~ ~o~ Tem~o~o~ Ced~co~e ........................................F~no~ Certd~co~e X Construction on above described building and permit meets all applicable codes end regulations. cant ,,z..n.,c.. :.../... ............ Sworn to before me this day ...~ ............ Notary Public .................................... County (stamp or seal) TOWN OF SOUTHOLD Building Department Town Clerks Office $outhold, 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 fallowing; 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. C,, Fees: 1, Certificate of occupancy $5,00 2. Certificate of occupancy on pre-exist~ng dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 · / -- New Building .....~. .............. Old or Pre-existing Building ............................ Vacant Land ............................ · fl 11 Location Of Property ..~l/~.fL,D~l~i~l~...D~,.V.~ ..........~,~l~,~.~t~,...~9.1~,~...~.~..'l;.~.~.?j ............................. Owner Or Owners Of Property Inland Hc~es / G. Wesl:hall ' ~ La~,~'el , ~ 21 Subdivision ............... .¢;;; ............................................ ~-or No ............. Block No ............. House No ............. ~ 6/1/73 Inland Home~ Inc. Permit No. 662'7 'Z. Date Of ~-ermit .................... Applicant .................................................................. Health Dept. Approval .~..~.0..-.~.~......-...~.~...~./..~.~. ..... Labor Dept. Approval ................................................ Nl13017 ., . Underwriters Approval .............................................. ~ann,ng Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .......... .~..?...,~...5.....,0..0. ....... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~FA.~..~....~, ,..,~,.o..~,.e..§, ..~.~...c.. a.../.....~. ,e.., .n~.. ,e...~..~,....~.?....,,.'~, .~.~..,e. ............ Sworn to before me this Notary Public .................................... County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE,SEWAGE DISPOSAL SYSTEMS Approval to construct said syste~ is requested,pertinent data herewith.' 1-Applicant ~ ~ Me Phons 6-Sub div Address ........ ~ ___~ ~ - ~__ ~-Sectio~ 2-De~il~ p~ lo~tion _ ~ ~et ~ T~ ~ 9-~ivate ~117 ~-~blic ~ter ~pply ~e ~s~nce ~ n~rest ~in ~-~t Size~ Width~ft. Le~h~t. (also en~r on cente~ plot plan below:) %-~elli~: Sidle Family ~ ~ F~m~ly? ~'Cellar? ~lab? ~C~wl S~ce? 10-~s~ ~st~= Septic ~ ~~Cess~ols ~S~llow ~ols il-Septic ~ i~ide d~ensions: Vol~e~ls.Lengt~f%. Width ft. Liquid dept~ft. 12-~ecast section: ~N~r~Sq~ Cess~ols: Block size~incs.D .~s.H~. i~et: To~l blocks below ~ ~1~2 ~T Ca.clip. als 0 2 '6 8 12 18 Street I No~t]~ 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". FOR HEALTH ~PART~ USE ONLy. ~s~ on the info~tion present~ her6~th, it is the opinion of the H~lth De~ment, that an ad~te a~ satisfacto~ S~e ~s~sal S~tem can be i~tall~ on this ~ot. Dat~~ Sign~ ~ '~ ( 0/65 S-15 DIETZGEN 135 ,846 UNAb'THOEIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF )'HE NEW YORK STATE [DUCAT/ON LAW CO'~I~S OF TEllS SURVEY MAp NOT BEARING THE LAND SU'~VctOR'S INKED SEAL OR NOTE: · -- MONUMENT SUBDIVISION MAP FI£ED IN THE OFF/CE OFTHECI EI~I~ OFSUFFOI K COUNTY ON dUNE ~2tlgZOAS FI£E NO. 5~IB6. REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOUNG SURVEY FOR: INLAND HO~ES,INC A'r L A U R E L I 'rowN o~ SOUTHOLD SUFFOLK CO., N.Y. SCALE: I" = 40' DATE: MAY 18,1973 ['R~F'~-454 ~ ~IETZGEN 135 ll846 [.of ~ 0 ~ ~ ~ o REVISIONS dULY2,1973 AUG. 27,1973 SEPT2I, 1973 NO TE. · = MONUMENT SUBOIVI$10N MAP F/LEO IN THE OFFICE OFT/YE CLERI( OFS~JFFO£/~ COI. JtVT¥ ON YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG AT LA U R E L TOWN OF SOUTHOLD SCALE' SURVEY FOR: INLAND HOMES,INC LOT NO, 21," LAUREL COUNTRY ESTATES" SOUTHOL~ SAVINGS DATE ~. il SOUTHOLD, N. Y. Examined .................. 197...;.~.. Approved ........................................ , 39..~...~... Pemit No,//.,.,.~...,Z,,~'* FORM NO. 1 TOWN OF SOUTHOLD ~"I"' ~ '~('' ~ /" ~" ? TOWN CLERK'S OFFICE .~/ C~ .......... Disapproved a/c ....................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s apphcat~on must be completely fjIle¢ ~n by typewriter or ~n mk and submitted In tr~phcate to the Building Inspector, w 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buddmgs on premises, relationship to adjommg premises or pubhc streets or areas, . g~wng a detailed description of layout of pr6pertv must be drawn on diagram which ~s part of th~s apphcat~on. c. The work covered by this apphcat~on may not be commenced before issuance of Budding Permit d. Upon approval of this apphcat~on, the Buddmg Inspector wdl ~ssue a Budding Permit to the apphcant. Such permit ,shall be kept the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or m part for ant p~rpose ~vhatever until a Certificate of Occupancy shall have b granted by the Buddmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Budding Z, Ordnance of the Town of Southold, Suffotk County, New York, and other apphcable Laws, Ordnances or Regulations, for the construct~o buddmgs, additions or alterations, or for removal or demolition, as here~n described. The apphcant agrees to comply with all applicable la ordnances, budding code, housing code, and regulations, and to admit authorized ~nspectors on premises and ~n buddmgs for necessary inspect~o (Signature of applicant, or name, if a corporation) ,-'~ ~ /,t ~¢._~ ¢(Address Qf applicant)~ ~ ,. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bulk Gener&l Cont,:actor George Wes tha. ll Name of owner of premises .............................................................................................................................. ~.;:;~ ......... If applicant is a corporate, signature of duly authorized officer. Robert E. Hiltz (Name and title of corporate officer} Builder's License No .......................................................... Plumber's L~cense No. 517-P Electrician's License No. 273-E Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ..... ..5..4,.8...6. ............................... Lot No ......... .2..1. ......... Delmar Drive Street and Number .................................................................................................. .:~ ................ '1~1~'~i~i~'¢¢(~ ....... d construction: 2. State existing use and occupancy of premises and intended use and occupancy · . a. Ex~stmg use and occupancy ..................................................................... : .~ ........................................... b.Intended use and 1 Family Dewelling ~_~ - occupancy ................................................................... ~_'..__~. .......................................... ~. Thi~ 3'~ of d, ~ ~ of' thil II~ii~l~ion, the Building Inepactor will the ~.~i. ,v.ii~de for ~W.etion ~hout the work. ~lmrt f~r of Building Permit. Permit to the applicant. ~uch permit ,~hatl be ~iCe~t. ifi~lte of O~ shell h~ve APPLICATION IS HEREBY MADE to the Building Department for till i , ,~.lRam of a Building Permit pursuant to the Building Zone Ordinln~ of the Town of ~mthetd. ~ County, New York, lnd oth~~LJws, Ordlninces or Regulations, for the constru¢tion o~ buildln~10 IEidt~ionl Or' Iltllfttlom, ot' for mmovll or dlmolition, Is herein ~iid/~ NN34.ic!nt .greis to comply wi~h Ill al~lk~bll Ilw~ Ordinmoel, building codl, houltng codll, md regulltlonl, ind to idmi! i~hori~H~ ~rs on premilel ind in bulldtngl for ne,lilly Iml~'tiom. . , State whether applicent is owns, Ira, ~gent, architect, engineer, electrician, plumber or builder. N ,~a~e, of owner of premises IS applicant is a corporate, signature of duly!authorized officer. ........................ ....................................... ..... ~N~ a~d.:~de of eomorm ~f~) .. .':.~ '. .... Builder's License No ..................................................... Plumb~ $ Licama No ...... =: -- ~ '~ ........ Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which I~o~o~d work will be done; Map No ..~1~6 Street and Number k~li~' ]~ 2. State existing use and occupancy of premium and a, Exiatk~,uae am:l × Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration .............. Repair ......................... Removal ......................... Demolition ........................ Other Work .........: .......... ~ .............. (Description) 4. Estimated Cost ........... .~..3..0.. ~..0..0...0. ;..0...0. ............ Fee ................................................................................................. (to be paid on fdmg th~s apphcat~on) 5. If dwelling, number of dwelling units ..... .~ ......... Number of dwelling units on each floor ............ ..0....., .................... 2 If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed occuDancv, 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 ....................................... 8. Dimensions of entire new construction: Front ..... .7...:1...~...8.'.'. ........ Rear ...... .7...~..'..8. J'. .......... Depth ....... ~..2..0.. .................. Height .......... i ................ Number of Stories3:~).~ ........................................... 3..62.~ .................. ............... 140 .......... 9. Size of lot: Front ...................................... Rear .......................................... Depth ................................................ 10. Date of Purchase ..................................... Name of Former Owner ........................................................................... 1 1. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................................... 13. Will lot be regraded ..... ¥~s ...................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ................ C..................~om49e..~e~.t~&;L1 .................................................................................. (Address) (Phone No.) Name of Architect ..........Ia.l_a. z3.cl..I-/o~e.s .......................... E;.~,.(;I.~..~..~..N.:..~..;. ....................... . .7. .3. .2. . .-. ~ .1. . .7. .7. ................ (Address) (Phone No.) Name of Contractor ....... ~..z3.1.~.d....~.o...m..e..s.. ......................... ..S..e..1...d..e.~..~..:..~..,. ........................ ?. . .3. .2. .-. . .~. ?; .?. .7. ................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. COUNTY OF..~.~.'~~-~.-~ .) SS ........... ~o~..e~..l;...,,~.. o...~.1~.~. ................. being duly sworn, deposes and says that he ,s the applicant above name (Name of zndz~zd~! ~nzng contract) He ~s the ........... (~r~,3'. '(~ot3."c~'~c'~o~ .............................................................................................. (Contractor, agent, corporate officer, etc J of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and hie th~s apphcatmn, that statements contained in this application are true to the best of his knowledge and behef; and ~.~l~es~'l~f.B~vlll be performed in the man set forth in the apphcat~on filed therew,th NOI'AI~Y PUBLIC. S~ate of New York No 52 884110¢1. Suffolk ..... ~,./ . ..,"~... day of t_.~.......¢~. ......... 19 ...~'"~ Term Exp,re, ,,arch 30 ................. 0 17o q 'o ",~ g 'J" II . L AP[-R£~VFD ,AS NOTED~' ED 1, B~FORE BACKFILLING FOUND~- 3, FINAL WHEN 'J~B, ....