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Home My WebLink About7361-zFOBM NO. 4 TOWN OF $OUTHOLD BUII.i~ING DEPARTMENT Town Clerk's Ol~ice Southold, N. Y. Certificate Of Occupency THIS CERTIFIES that the building located at ~ ~.[.V. 0...~.~ t .~.~.~..[~.. ~. ~.t"'Stme/~. Map No .... ~.?.~.~o .... . ...... Lot No ...... .~ .~ ........................ conforms substantially to/he Application for Building Permit heretofore filed in this office dated .............2.5 .JY.a/g'lg. 7.~{ pursuant to which Building Permit No. 7..~6.1..~ dated ............'~..~. ~J/~/[., lg7~.., was issued, and con/orms to all of the require. ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... .~.. O~ [. ..... ~J~ J'.~. I .L..y. .... .~)l~/£ k.t .L N .~. ..................... The certificate is issued to .. ,[ 0 {~. ~. I...~....J~ ~..~..L--..~. ]~ ~ .... .'~. ?..~. [ .-~..~..~. !..~. ..... (owner, 1~) of the aforesaid building. Suffolk County Department of Health Approval .*.°/:,l~'! .~.. ~.0: .7. Z, ..~..' UNDERWR~TEI~S CERTiFiCATE No ......... /IZ../~. ~.0..7. g2 ................. UOVSE ~r~ ... ~..,/.7 ~.. Strut. . ~ ~. t~.~. P, r< ..... .~.-~. ~..q. ~ ....... ............................ LaURa: L_ Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7361 Z Permission is hereby granted to: ~land ..Home s...~ ~c.....A/.C J.~hn..& ..D.eae t r~ ]~en~evSs ......... ~'~a.tA; ~..'buek ................................................. to ~ .4... ~.e.~ ...o..~.e....~..~.:L.~....~..e.L~g ...................................................................................... at premises located at ..],~).~..~...,.[t&l~L~e't..l~.~IZ13,~....~.~.~S. ................................................. ............................................. l~.e~...P.~,y.~ ............ .~a.~.o.1. ........................ : .................................. pursuant to application dated .., .................,.....~TM~3~.....~,~. ......... , 19.~...., and approved by the Building Inspector. Fee ~..1..,3 ~. ............. Building Inspector FORFI NO. $ TOWN OF 5OUTHOI. D Building Depn~ment Town Clerks Office Sou~hnld, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructinns 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 ~nd sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mu~tip!e 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 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buJJdJngs. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent 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 New Building ...~ .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~`~.~``~9.~.~.~.D..~'.~..I~e...~`.~.~..~D..z..~:.~.~'~.~.~...~.'~..~e.~ .................................................... Owner Or Owners Of Property ...... ~...~I~....A~....,~....~..O.'.~.~.....~..~..C..; ...................................................................... Subdivision La~.tx'el Countz'~ Estates Lot No 34 Block No. House No ............. Permit No ........ ~..~..6..~..~. Date Of Permit .6./...~.~/..?..~.....Applicant .J.....&....D...~..e..~...l;..~..v..~.~. ................................. Health Dept. Approval ...],.0./.,~../.Z.~.. ......................... Labor Dept. Approval ................................................ Underwriters Approval ...~....1.~..6...0..'7...O. ....................... Planning Board Approval ........................................ Request For Temporary Certificate ..... .n...o. .............................. Final Certificate .... ~.e...s. .............................. Fee Submitted $ ...5,,..,,0,.0. ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant - _, INL~N-D I-{O~D-~ I~C, Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County bot ~NDIOR FROM DArn OBTAINED F~OM OTHERS and.water supply The sows. ge disposal location hays been facilities for thiS~~ ~ inspectod~ e ~bY th~, . ~ . APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Inland Ho~m~ In¢, Phone Addressl ~ 117, l~l:~i~ucl~., N,¥, 2. Property Location 'l~lt~ Village laurel Township 3. Public Water Company Name 4. Lot size: Width ~3il feet Length I~6, feet 10. Sewa~i s pos al System: A. pygallon septic tank: Prd~st X Equivalent Block B. Leaching pools: Number of pools ~ Precast~Block Special ll. If private well, fill in the following blanks: . A. ~ank capacity .411 gallons B. 'P~mp G.P.M. 5 C. Total well depth, 9o D. D~ePth to ground water 40 E. /~unt of water in well 40 The unders'i~ned CERTIFIES: "Construction of 5. Subdiv.Lauxml 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date Jur~ 7.. 1974 Signed ~_, __.u_ :~_.r:::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 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 and Water Supply can be installed on this pl~ot. APPROVAL DATE (t/~7~ SIGNED ~__~ ~ , S-1 5 Rev. 411/73 Lot 33 Lot 3b Y~UNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK SURVEY FOR: · /NLAND HOI~ES, /N~., L O T NO 54, "LAUREL COUNT~~~ AT GUARANTE · & su[[o~ co., ¢. ~. ~ ~ ~ sc~: /,, ~ ~0' ' 'JUNE~,Ig~ '~7 ~U~D, N. Y. Examin~ .................. ~.:?......, 19...?..Y ~plicotion "o...2..)...~..[ .............~ ~pr~ ...~ ........... :,~ ...... :.'. .......... , 19....:.:. Pe~it No...~..~.~..L..,~....~z~ ~ ~_ ~ ............................................................................ .......... ....... , ................. .................. ate ....................... , .... INSTRU~I~S ~ a. This a~lication mint be c~pletely fill~ in by ~ewriter ~ in i~ a~ s~mi~ in triplicate ~ ~e Bui~i~ In~tor, wi~ 3 ~ of ~l~s, accum~ pl~ plan ~ ~le. F~ acc~ ~ ~h~ule.~ b. Plot ~lon shying I~ation of lot and'o~ buildings on premises, relatib~shiP to adj6inJng premises or public stree~ or~ areas, and. givi~ a detail~ d~ripti~ of I~o~ ofpr~e~ must be drown on the diagram which is ~ of ~is applicati~.~ c. ~ work covere~ ~ thi~'~licetjo~ may n~ be comme~ ~ef~re ~nce. of ~uilding Permit. d. U~n approval of ~is application, ~e Building Ins~tor will issue a Building Permit to the ~plicant. Such permit shall ~ kept ~ the premis~ ~ailable ~r in~ti~ thr~hout t~ work. ~ e. No buildi~ shall be ~cupi~ or u,d in whole or in ~ for any pu~ose whoever until a ~ifica~ of ~cupan~ shall h~e been granted ~ the Building In~tor. APPLI~TION IS HEREBY ~DE to the Building Depa~ment for ~e issuance of a Building Pe~it pu~uant ~ the Building Z~e O~inance 9f.~ To~ of ~hold, ~ffolk ~un~, New York, and ~het-~pli~ble ~s, OMinances or Regulation, for the constru~on of buildings, a~itions or alterations, Or for removal or de~ition, as heroin de~ribed. ~e applicant agrees to comply with all a~licable la~, o~inanc~ullding c~, h~si~ c~e, a~ r~ulati~, a~ to admit authoriz~ in~to~ ~ premises a~ tn ~ildl~ ~r n~e~ i~ti~s. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ~e~l....~,g~.e,~ .~.~.~; ....................................................................................................................................... Name of owner of premises ....jI;gl~.~...Qt~lle.~..l~ll~.l:.~l~.l~..: ..................................................................................... If appli ant is a co orate, s' at. ure f duly authorized officer. (Name ,and title of corporate officer) Builder's License No ..................................................... Plumber's License No ...... ,~I'Z..-.~. .............................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ....... ~ ............. Street and Number ..... ~il~al~'...Dg~l~V~e...i~,tt~,.~L?...~e¥-e ............................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of 'prOpOSed construction: Exisiting use and occupancy ......... ~l.(:~l .............................................................................................................. Intended use and occupancy ...................:~....~.~..m.~.....~.~ ....................................................................... 3. Nature of work (check which applicable): New Building ,~,.XX ....... ~.. Addition .............. ..J. Alteration ................. Repair .................. Removal .................. Demolitiom ................... Other Work ............~1.{.. ......... i ............................ ~ -~ (Description) 5. If dwelling, number of dwelling units ...OD.e .................. Number of dwelling units on each floorj ............................ If garage, number of cars .................... ~ ........................................................................................ t ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of us~. ............................ 7. Dimensions of existing Structures, if any: Front ............................ Rear ................................ Del~th .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rearl ............................ Depth ................................ Height ............................ Number of Stories ................................ I 8. Dimensions of entire new construction: Front ..... .~...3..? ........................ Rear ......... ~..~ Del:) Height ........Z..8. ......... Number of Stories ...... ...O~...e. ..................................................................................... - .................... 10.~ Date of Purchase ........................................................ Name of Former Owner ..........................! .............................. 1 I. Zone or use district in which premises are situated .......... .~....o~:....e..s. ................................................ ~ .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~O .............. ! .............................. 13. Will lot be regraded' ......YES ............... Will excess fill be removed from premises: ( ) Yes j (X) No 14. Name of Owner of premises ..~T~hn .~z~t;e. xZ:J~ ...................Address ..I~¢.O~Z~I3...N~Z, Phone~ No ....................... Name of Architect .............................................. : ............... Address ................................ phone .No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-baCk dimensions from property lines. Give street and block number or description according to deed, and show street ~ames and indicate whether interior or comer lot. ~3'~', O0s STATE OF NEW YORK, COUNTY Of ................................ ~'~ ................................................................................................. being duly sworn, deposes and says t~ he is the applicam above nam~.(Name of i~ividual signing contrac~ . ~ ' ' ~ . il He is the ................ ~.~.~q~ ....................................................................................................... J ................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work a~d to ~ke and file this application; that all statements contained in this application are tree to the best of his know~edge and belief; and that the work will be performed in the manner set fo~h in. th, appli~tion filed therewith. Swam to before me this ........ ........... ........... ...................... , J , Nota~ Public, . ........ . ~;.~n~ (Signature of applicant) · ~ta'v p~ic, THE NEW YORK BOARD OF FIRE UNDERWRITERS .R.W BUREAU OF BLECTRICrT~ , '~ ,, 1~ October' 4 Rl~748S JOHN STREET. NEW YOR~ .~?~ ,0~8 ..,. ~.~.,~,~o.o.~ '' ~' ' N 186070 THIS CE;IFIES THAT ~ t~ e~t~ ~u~pment ~ ~eH~ ~ m~ int~u~ ~y t~ ~l~t ~ o~ t~ ~ ~ication numar i~ t~ p~m~s o~ w~ erami~ on 0 C t obe~ 1,19 7 ~ and found to be in compliance with the requirements of this B~rd. .xvu~ ~XTOt~S ~S %VmS mS~ WASHerS ~XHAOST FANS OUT~$ 17 DRYERS PJRNACE MOTORS TIM~ CLOCKS MULTI-OUTLET DIMMERS SYSTffMS NO. OIr I~ET SERVICE DISCONNECT S E R OTHER A~A~T~: ~oto~s:l-3/~hp ~Furn&ces:l-1/Shp,2-1/1Php OF CC. COND, OF NEUTRAL t~- Patchogue RL. T. 11772 1! COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. !,