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Home My WebLink About8563-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z. 9.0~ .... Date May 25 19 78 5005 Laurel Lane THIS CERTIFIES that the building located at 30. Gr. · ~ec.. Bay. Blvd.... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .Ma.rg.h... ~ ......... , 19.7.6.. pursuant to which Building Permit No .... dated . .~.a¥ ...... ~ ...........m..76, 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 .. S..~..S.0N.~...Q.~...F.~..ZLJf. D..w~..LING .................................... The certificate is issued to ...W.$~..]..i..1~` .& ,M,a.t~, ,~,e, ,~, M. qN..u%.~y ........................ (owner~) of the aforesaid building. Suffolk County Department of Health Approval ..... 6.-S.0.-5~ ...................... UNDERWRITERS CERTIFICATE No ...... N~ ./~.$.~.8 .............................. 5005 Laurel Lane HOUSE NUMBER ...... 30 ...... Street ... ~l~ea~c. I~.ec~n.i.0 . Bay .Blvd, ........... ......................................... .ka..m'..~.z.,..~. ?:. Y.*. r.~. ................... Building Inspector TOWN OF SO~THOLD BUILDING DEPARTMENT 'TOWN C:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8563 Z Permission is hereby granted to: ~.....f~....~r.~x~..~..~..ty. ............................... ~ M..oJl~t ? ce G~eenlawn to .Bu.i...1..d....n..e...w...o...n.e f~.i..ly d.w...e..1...1.1, ng (approved by Bd Appeals) at premises located at ..... F./~..Laur. el..Le.n_,...~_.P, acm~lc...~a2. ................................................ ..................................................... ,EamraL....N.,Y, .............................................................................. pursuant to application dated .................... A~......9. .................... , 19..7..~.., and approved by the Building Inspector. Building Inspector FORM NO. $ TOWN OF $OuTHOLD Buildlng 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 triplicate 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 and sewerage disposal--(S-9 form or equal). 3. Approvo~ 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 aT 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 ................................................ New Building .................... Old or Pre-existing Building '/ Vacant Land Location Of Property .... ,. . Owner Or Owners Of Property ..... .~...,c'k'~..;..i~......z'.~ ........ .~...~ ....... ~ .......................... Subdivision ........ , ....................................................... Lot No ............. Block No ............. House ISIo......, ...... Perm,t No... Date Of Perm,t .~/3,;~ 9'~, ~._¢/ , ~/~ ............ Health Dept. Approval ...~..~.x. ............ Labor Dept. Approval Underwriters Approval ...(~J,/Zt;~'...~F....~.. .............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final ;Certificate .......................................... te Fee Submit d $ ......... ; ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .../.~ ~.... ~...~....~ ....~...~.. ~ ........................................... Sworn to before me this doy ..:...../..,F..'Z..Z ............ Noto , .......... Coun,¥ (stamp or seal) ,,:,; ~ ~HE'?"i~E~ ~RK ,BOARD:uFtIRE'` UN~.E,RWRiTE~i-~r;::: ,, · TH S CERT f ES THAT ....... OTHERAPPARATUS:'' Ru!.and Elec, Co,, . P,O,Box ~iattituck, L.I, ' ?,i952 _ ~ Lid, 242E This certificate must not be altered in any manner;, return to the office of the Board ~f i~orrect[' INspectors ma), b~':idenfified Disapproved a/c ........................... ~ .............................................................. ................................. ........... '"T' .............. .............. ~\ ~'~' k)~"-'" (Building Inspa~tor, ~ ,,~ '~v~ 'q APPLICATION FOR BUILDING PERMIT ~ Date ...3~RC~..g ............................ ,19...2~..... INSTRUCTIONS o. 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 os areas, and giving a detailed description of layout ofproperty 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 will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been grunted 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 or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with allppplicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premise~ and in buildings for necessary inspections. ......... ............................ (Signature of applicant, or r~me~lif-a corporation) · 3O..MON~T~ ..R~,E.,...~~.. H. X ~.. 11.7.t Jh ...'~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .............................................................................................. Name of owner of premises ........ ~,lo~hn...F~...NgNGl~,¥.r...[,a~a~.e]~.r..N.r¥., ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~..~...~.;..fl~. Plumber's License No...M~t,t,i~,ue,.k..~.laatl~n~..& Heating Corp. Electrician's License No. .~..:.....~........~...U..~....a~...~...~....~.~'.~... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .... E~...coz:rt~-~'...Tua.LL~etl..T.,a~e.~...g~oon,L~..~,a.¥..~l,$/.~l,.r..~ ........................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....................... .V.a~,,azi~,...1,a.~l, .............................................................................. b. Intended use and occupancy ............ ~,q~tg,l,el...~lll;L~.~....~l,w.~..],~..~.~.g. .............................................................. Repair .................. Removal .................. Demolitior .................... Other Work ...~...e..e....N~/A~..],..~f~,],Q.~. ............. ~ ,~,,e,,, ~_~..~ fd (Description) 4. Estimated Cost .................... ~..7...5..0...0. ............................ Fee ....................................................................................... (to be pa'd on ' lng this application) 5. If dwelling, number of dwelling units ......O~:....e. ................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 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 ..,4..,6..~.,..+.....1..,0.."..]L3~..r.,q~. Rear ......~....a~...e. .............. Depth2...0..-...2..3..:.5..'. ...... Height .~..l...-.~.;~.". ...... Number of Stories ..... .o.n..e. .......................................................................................................... 9. Size of lot: Front .............. 4...~.,3, ................................... Rear 452 Depth 52 p, ,~h~ obtained b~ will in 1943,. 10. Date of .............................................................. ixlame of Former Owner .~h~".l~.~....~..~....~g,~,.~,~..t,y. ........... 11. Zone or use district in which premises are situated A Residential A 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... .~.e...~. ...................................... 13. Will lot be regraded . ........N..o.. ............... Will excess fill be removed from premises: ( ) Yes ~ ) No 14. Name of Owner of premises ...J..9~...F..o...H~N~/I:t,y. .............. Address .....Ls~g~'.ell. ............ Phone No...2..9..8...~.4..,6.~.8.... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....... E...r..n...e..s..t.....J...°..n.,e.,s. ........................ Address ..M..a...t..t..,i.,t..u.c.k.. ......... Phone No..2...9..8..7.,8..6..6...3... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. See attached survey by Young & Young of subject premises, dated March 3, 1976. Note 1 - It is propose~ to move two small buildings (18 x 20 and 24 x 20) onto the premises, connect them with a four foot addition to comply with minimum equ~are footage requirements and erect a deck on the bay fron~side~of the dwelling. STATE OF NEW YORI~ o- ~ c c COUNTY OF ............ .~..~..~..~...o..]....~... ~ ~. ~ ................................................................................................. being duly sworn, deposes and says that he is the opplicam (Name of individual signing contractO above named. He is the ......... .lfL~.fL~.~. ......................................................................................................................................................... (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 tk, az the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........................ day of ...~.~.~ ............................. , 19...~.~ - NotoF Public, ~ ~ ~/C Coun~ ............ ~...~....~. ............................. (Signature of op~li~) '~ JA~,~ES F. YOUt~G ~ota~ Public, St~t~ ~f ' , , No. 52-43~Z ~25 Qua ~ ;~d ~n ~t ..... ~ , y ~Dommission ~pires taarch ~0, Z~l,~ HOLE ApPL~CAN F ADDRESS 'SUI~FOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF COH~T~::UCTION ONLY DATE , HS REF :NO. APPROVED -PRIVAT[ W~LLS 5 MILES UAND SURVEYORS ,)ER AVENUE NEW YORK' · NO 50' . 76-94 T~ST HOLE REVISED, NOV.23, 1977 NOTES I MONUME N F]: STAKE WATER SUPPLy- PRIVATE WELLS NEARE~.ST PUBEIC WATER- 5 MILES + LAUREL SOU~HOLD SUFFOLK CbUNTY, N. Y, YOUNG & YOUNG,.¢AND SURVEYORS 400'OSTBANDER AVENUE' R'IVERHEAD, NEW YORK DATE . SCAEE NO 'MAR 3; 19~6 , = 50 76-94