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,
....