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Home My WebLink About8760-zI~OKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~ $'~ ........... ~ ~)t~ L M ~7~. ......... ])-~x.V?Street Map No ............ Block No ........ Lot No ................................. conforms substantially to the Application for Building Permit heretofore filed in this office du~-~' ?-. ~, 7~, ' ~'7 ~ e dated ...... ~] ~J I.~r 'a27",19 7~' pursuant to which Building Permit No ......... dated ................. 19... , was issued, and conforms to all of the require- ments of the ap~plicable provisions of the law. The occupancy for which thJs certificate is issued is A ]:~'~V~ 'r'~ O~E F~"~t-'T ~ ~ ~ ,~ ~ The ce~ificate is issued to ................... , ...... ; ..................... (owner, ~ ..... ":~:.~t ) of the Moresaid building. S~o~ County Department of Health Approv~' ~" ' .... 77 ~..., E~... ~: ~-. ~? t UNDERWRITERS CERTIFICATE No ........................................ HOUSE NUMBER ~ ~ ~ Street ~E ~ ~ ~ ~ ~x ~ ~- B~di~g Inspector FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. B~UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8760 Z Permission is hereby granted to: z..~ !~.4....$., .o.~.e..~....z.~.e.. ......................................... Mattituek to Build new or~e f~mily dwelling at premises located at Lot. 17 Lat~eI Colxnt:~j' Est, ares ~ ..................... : ........................... .r...~ L,..a.~..p.~.t...,,.a. ......... ka.~,e.! .......................................................... ....................... ~,1~.,]:.Z....,2...~. ............. , 19..~..,~.., and approved by the pursuant to application dated Building Inspector. F.e ......... FO~ NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCGUPA~NGY 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. F~nol 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. Commermal buildings, ~ndustrial 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 apphcable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~stmg" land uses: 1. Accurate survey of property showing all property lines, streets, buddings 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 pre, raises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certif,cate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 Date November 15, 1976 New Building .,.X..¥. .......... Addition ................ O~d or Pre-existing Budding ..... i .......... Vacant Land .............. Location Of Property ~....D..e...~.r..a.a.'.r.~...D..r...i.~.e..~....'L..a..u'..r...e~..~:....N..:~.Y..t ................... ~. .............................................. Inland Homes, Inc. Owner Or Owners Of Property ....................................................................... ~ ............................................... Subdiv,sion .L...~..t.t.{~..~....C...°..~...~.~?.~:....~..s...'c..a..?.?..s. ........... Lot No .....3..7.. .... Block I~1o ............. House No .....~..3.5..5 7/27/76 · Inland Homes~ Inc. Permit No.8.V.~.O..Z.. .......... Date Of Permit .................... Apphcant .......................................... Health Dept. Approval .1..O.../..2..1.../..'7./?.......6..-...S..O...-..1..4...1..kabor Dept. Approval '~.....~!../..r. .................................. O N 30962~ 10/28/76 ., · yes Underwriters Approva[ .............................................. t~lannmg Board Approval ........................................ Request For Temporary Certificate ..J.A;D.~ .............................. Fine[ Certificate ....... ~;.~;$ ........................... Fee Submitted $ ...5.....,0..0. ......................... : Construction on above described buiiding~l c~ble,/Codes and regulations. Applicant '" Sworn to before me this V/? ................ day of ............................................ Notary Public .................................... County (stamp or seal) lZ l "" . _ , i,,,. .35 JOHN STRE~ZI'. N~W YORK, NEW YORK 10038 ,,,,,,,.,,,o,, ,o ,,,, N 309629 t r~ .~ oqu~pm~ ,, t a~ d~.~cr~bod below ~.d in~ro,h~ ~ d by the ~{ppl~nt named ~n the ~;bot'e ~ppHcatlon ~mber in the pren~sos of Inland Ho.aes~ Delmar Dr~ve, Joseph St. & Glna t;,ef,,.o,,i.~t~'..~ X] n ...... ,~.t ~ z.,m. ~ } ~,,a n. outside ~., ......... a,,. Octobe~ 22~ 1976 ~7 ..... 1 .. -~-- t ...... ~uR~ ...... ~ -~x,;~s_ -~ ~5d6i~F~bg~s~ -- or,' ~U~'~CE L~OTORS ~ FUtUrE APPLIANCE F/EOER~ SP~CIALRE~';~ TIM~C/~CK~E[L DtSCONN[C~ ~NO b~ S E ~ V G.F.C.I. Sv~oke Detector Richard Relyea~ D~- -, .... ~ a, 0riva, Box 372 T,a,,v,?, L.T, 11.948 Lie. 2lgSE Per ,~ to the ~ ~*, - ;f ~ha Board i~ incorrect_ Ins~eOors n,~y ~,-. Di~pprove~ ............... ~ ~ APPLICATION FOR BUILI~NG PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises;, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building InspeCtor wil~ issue o Building Permit to the applicant. Such permit shall be kept on the premiees available for inspection throughout the work. e. No building shall be occupied or used Jn whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the~) Building Zone Ordinance of the Town of Southold, Suffolk County, New 'York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and toc~ admit authorized inspectors on premises and in buildings for necessary inspections. (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. ............................................................................ .c..t...o..z.. .......................................................................... Name of owner of premises ........... ~...a~...d.....~..~.S.j....~...~..C..e....i ......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......... .5...3....~...-.¥. ........................... Electrician's License No ...... .~...7.-~'..'..~. ........................... Other Trade's License No ............................................... 1. Location of land on which proposed work will ~' ~, done. Map No.~.i~...e...~...,C.o.~t~..~....~....~l:Li~$lR~ ........ .Z...7. ............ Street and Number .......... ...D~..~....D..~...iV...e.......M..&..!:.l;.i..!:.~.g~,..~].,~¥~, ................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy Va. cazl'~ b. Intended use and occupancy .............. :I'..'.?....~....~..~.Y. .............................................................................................. Locate clearly and distinctly all buildings, whether exi property lines. Give street and block_/number or whef~er interior or corner Iotq~-,,) 3. Nature of work (check which applicable): New Building, ..~ ........ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... - /,,/. ~ (Description) 4. Estimated Cost ..........,~.~...5.,~.~..O...O. .......................... Fee ........................................................................................ ~.~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...........Z...~..z....g....~...~.g..e. ..................................................................................................... 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 ................................ 8. Dimensions of entire new construction: Front .......... 5~.-.~, ................ Rear ...... 54~.~ ............ Depth ........ 2~. ........... Height ...... .Z...~. ......... Number of Stories .......... .3. ......................................................................................................... 9. Size of lot: Front 140 Rear 3.50 Depth 3.50 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 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 . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .....~...~...~...d.....~..~.s.~....Z...~.g. ....... Address ................................ Phone No ....................... Name of Architect .............................. ,::;.;' ................. : ...... Address ................................ Phone No ....................... Name of Contractor ....: ......~.~...Z....~...~.....H.~.~s...~..~..9.? ...... Address .~...Z:..Z..? .............. Phone No....~?..8...-.?...6.?...6 - PLOT DIAGRAM . \O~,a~t~i~uCks~_ N.Y. and indicate all set-back dimensions from to deed, end show street names and indicate STATE OF NEW YORK, I S S COUNTY OF ............. .,M ............. ~ ' .................................... ' ................................... ~ ......................... being duly sworn, deposes and says that he is the applicam (Name of individual signing cdntFbct0 above nomed. Cont~&¢tor He is the ................................................................................................................................................................................. (Contractor, ogent, 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ dayof ............................................ , 19 ........ i/ ~--~/~l / ) ~j/~ / Notary Pubhc, . ................................................... County ...................... .~ ........ ~ ........ (Signature of applicant) THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DI.~POSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTME,~ OF HEALTH SERVICES APPLICANT. ADDRESS ....... TEL ___ COUNTy HEALTH DEPARTMEN2 The sewage disposal and water suppl7 facilities for this location h~ve been inspected bT this department and found to* be sa~to~. ~ __ . .~ er of General En~~- Se~ices Lot 16 NOTE: I -' MONUMENT SUED~VIS~ON MAP FIA,I?D IN T~ OFF/CE OF THE CLE~qK'OF SU,~LK COUNT~ ON dUN~ ~,lSYO A~ FIL~N~ 54~ WA~ ~ERVIC~ = ~l~rE WELL NKARG~T P~L lC WA~ M~N ~ G M/~S ~ jOSFPH R£Vi~,IONS OCT I~, 1976 YOUNG & YOUNG 4001OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: INLAND HOMES , INC. LOT NO. 17 "LAUREL COUNTRY' ESTATES ' AT LAUREL TOWN OF SOUTHOLD SCALE I GUARANT£ED TO' SUFFOLK CO, N.Y. 1'~/~ = 'qO JUl.. Y ,21, 19 ' 5 Lot I1 ' ~w,O~8 sO ft. AreO '~, Lot 16 NO T£ .' I = MONUMENT SU~OIVISION MAP PILED IN ~ 0~ OP T~E ~L~OF SUPPO~K CO~ ON JUNE ~ , (gYo AS FI~ NO. ~486 WA~R SE~VIC~ = ~fV~T~ W~L~' N~AB~T PU~ IG WA~ MAIN ~ G MI~ ~ THE LOCATION OF WELLS ANO CESSPOOLS SHOWN HEREON ARE FROM FIlL0 OBS£RVATtONS AND OR FROM DATA OBTAINEO FROM OTHERS THE -WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESiOENC; i WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTM~' OF HEALTH SERV~ ADDRESS 315 ~h~la ~ TEL~% R~ 117 ~ ~;h,~ Y. 110;~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY APPROVED REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOUI~G SURVEY FOR: INLAND HOMES , /NC LOT NO. 17 "LAUREL COUNTRY ESTATES" AT LAUREL TOWN OF SOiUTHOLD GUARANTEED TO' SCALE SUFFOLK'CO, N. Y I "= 40'