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Home My WebLink About8448-zFORM NO. 4 TOWN OF SOI3THOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy No. ZTI+O.~ ..... Date ........... Elee.. 3 ....... , 19.76 THIS CERTIFIES that the building located at . Woods-~.de. Le~e .......... Street Map No. Laud. el.wood Block No ....... Lot No. 1.~ · L~itret- · .NoY.. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Max-.. 2619.76. pursuant to which Building Permit No.. ~:~:8~ dated . Max' . .~-6... , 19 76., 'was issued, and conforms to al/ of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P. rivate olde t~illr .d'~t®J,3,:[l~g ................................... The certificate is issued to Robert .& Elsa. ae~mo~a .. ~nel*s ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Dee-. 3 - t 976- (~ee. note. on .appl, ova-~ BE~ ~nf&n~; use of w8 UNDERWRITERS CERTIFICATE No. ~30~768 · · Bept;. 30 '~9~6 .................. HOUSE NUMBER ... ?0 --' Street .. 'Woods~d~'Larm ...... Imu~'~]. .......... ~OEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8zt~8 Z Permission is hereby granted to: tO .................... if ................................. at prem,ses located at ..J~T~..~...../..~. ............ ~..:; ............................... .t ........................... L~,.~....~.~. ~..~...,. ............................... ............ ~.....-.=.), pursuant to apphcat~on dated ...................................... ~ ............. , 192...., and approved by the Building Inspector. Fee $.L~-..~ ..... FOILM NO. $ 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 mn DUPLICATE to the Building Inspector w~th the following; for new buildings or new use: 1. Final survey of property with accurate location of all buddings, property hnes, streets, and unusual natural or topographic features 2. Final approval of Health Dept. of water supply and sewerage d,sposal (S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, a cerhficate of Code compliance from the Archilect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-confarm~ng uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property Imnes, 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 ) ertificate of occupancy on pre-existing dwelling or land use $$.00 opy of certificate of occupancy $1.00 .................. ..... New Building ...~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ~.-~.~t~:~`~'~.~.~'~:~m.~..~.m..~.~..~.~..~.~*X:~ ...q....LL~. ...... ~ner Or ~ne~ Of Prope~y~~.~.~.~..~.~.~.~.~.~..~.~ .............................. .... Subdivision ~....~..~l..J.~].[.~.k~ ....... ~.Lot No. Block No ............. House No..'~,~. Permit No~ff~.~ ....... Date Of Perm,t~m~]~pplicant ~,~.~~.~1 ................. Hearth Dept. Approval .... ~.~.=~..~ ................ Labor ~pt. Approval ...~.~.~.~. .............................. Unde~riters Approval .~.~.~.~ ................. Planning B~rd Approval .~.~ ............................. Request For Temporaw Ce~ificate ....................................... Final Cerhficate .... ~ ........................... Fee Submitted $ .~:.~.~ ..................... Construction on above described building and permit meets all applicable c~es and regulations. Applicant ~.~.~ ................................... Sworn to before me this ...J~... day of ,~.e.m~,[.~.J..~76 I) Notaw Public ....... Coun~ ~ c ...... ' ~o,,,~ J '~, ',THE NEW ,YORK BOARD, OF FIRE~ UNDERWRITERS ~ L---il ~ L ~' ~l, il BUREAU OF ELECTRIGITY Robe~t,H.' Gabon, 70 Woodside Lane~ Laure~¢" L,I.~',, w~,, examined on ,, q~ ~ ~ ~ ~ ~' ' 9 R ~ O ~ ~ ,, and found to be ~n compli~hce ~ith the r~quirementa of this Board. FIXI'URE FIXTURES OUTLETS, SWITCHFJll FLUORESCENT ! DRYERS FURNACE MOTORS , FUTURE APPLIANCE F~EDERS OVENS DISH WASHERS EXHAUST FANS TIME (~LOCKS! UNIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS NO OF FEET OIHER AP~ARAT ~US;ih ~ Motors ,'',t~i~erhead¢' Thi~ cert~hcat~ must not be a teredhn any manner; retur~ t~ the office of t ,Inspectors may be {denhhed by their credenhals. ....... .................... ~, ....~ ....................... , ........ , ~...Z.~ .... . . ~, b. Plot ar~s, and gwt~ a ~il~ ~ipfl~ of I~ of~ m~t ~ dm~ ~ the d~gmm whi~ is ~ ~ ~ ~l~ati~. c. ~e wo~ ~er~ ~ ~ a~licati~ ~ n~ ~ c~me~ before issuqnce of Bui~i~ Permit. d. U~ ~al of ~is a~lic~i~, shall ~ ~t e. No bui~i~ s~ll ~ ~c~i~ or u~ in ~ole or in ~ for any pu~ w~er ~til a ~ific~ of ~cy sh=ll have ~n g~t~ ~ ~e Buildi~ In~tor. APPLI~TI~ IS HEREBY ~DE ~uild~ Z~ ~i~e of ~he T~.~ ~o1~,. ~lk C~, ~utah~s, ~r me c?nstr~ · app,~r ~ ro c~ply wnn a. a~,caDm t~, ~t~, ~.~ c~, h~:~ c~, ~ ~, a~ ~ · admit au~Hz~ in~ ........................... (Signature of applicant, or name, if a cOrporation) _ ,,, ,.,* · ................ .~..~-.~.-.~-.~. -......,...--U..(Address of applicant) '~ State whether applicont is owner, lessee, agent, amhitect, engineer, general contmct6r, electrician, plumber or builder. ......................... .& ~..L L~..~..,.L ~,.L~.~.~....Q..~.~.n..~. ~ .......................................... · .................................................... Nam~ofowneroforemSes ~9.~.~.~1; ~:1.,. ~.ammon: and Elsa D, Gammon.~ his wife If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... ~ ............... Electrician's License No...~ ......... Other Trade's License No ............................................... I. Location of land on which proposed work will be done. Map No.: ....... ~..~..9..~.. ........................ L~t No ....... ~.~ ............. Street and Number ......... ~N..o..o...d..s...~.~.e.....L..R.n...e. ............ ~...~.~.~e.~..,.....S..o..u..~.~...o.~.~.....N.'.e...~..'...~..o..~...~. ......................... Municipallty 2. State existing use and occupancy of premises and intended use and occupancy of prppar~d construction: a. Exisiting use and occupancy ........... .¥.iLg.~J~.L..~.i~.~, ....................................................... b. Intended use and occupancy ........... ~.~L..a..~.i,a.g~,.~...,~.~r~,~,3'...~L,.'~.~,~..~.~ ................................................... 3. Nature of work (check which applicable): New Building'. ...... ~ ........ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ..........,~..~.~.,D.~..Q.^.0.Q. .......................... ee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...(l~.fl....s.~.n...q.]:.[~..Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. [f business, commercial ar mixed occupancy, specify nature and extent of each type of use ............................ ?. Dimensions of existing structures~ ff any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. -:Oimensions of same structure with alterations or additions: Front .................................... Rear '"~'~;~'¢;'"~'~'~'a Depth ................................ Height ....................... Number of Stories ................................ West 74" 8. Dimensions of entire new construction: ~ront ............ .~ ...................... Rear ...~..~. .................. Depth ~a~.~...~2:: ..... Height ....~Q~'. ......... Number of Stories ...............q.~-~..--"~ ................................................................... : ..................... 9. Size of lot: Front ............. ~,.4.Q.^.$.~.~ ........................... Rear ......... 2.7.9~.],9 ................... Depth .2.1.(~...(l~ ............... 10. Date of Purchase ~./.5/.,.~.~ ........................ Name of Former OwnerF-Z-i.n..-U..L...-[[a~'.Y.-.~sa~-..,~,Ze~rand~ 11. Zone or use district in which premises are situated ....................&~,i1.(I~,.~...~.P,I~.],,Y. ......................................... (, ....... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ll~ ......................................... 13. Will lot be regraded ........~ ................ will excess fill be removed from premises: (X) Yes 4. Name of Owner of premises ,~aJ~.fl~'.l~..~....ca~q-~l~a-O.ll...e.t...u~AddressF..]'.i~'~[~.l~.~...~'~''' Phone No. Name of Architect ....~..fl.~.~,.&..J~.~.fi.t,.W~.9..~ ........................ Address ~[~.~.~.fl~.~,..~,,¥.oPhone No. 7.~.~.=.$.Z~0. Name of Contractor ...... .A.l:).P..1..i..c..~t.n..~-. ................................ Address ....B§...~]Z~..V. fl ......... Phone No ......~..~.....~:~: ..... PLOT DIAGRAM Locate clear y and d st nctly all buildings, whether existing or proposed, and indicate all set-back dimensibns from property lines. Give street and block number or description according to deed, and show street names ,?nd indicate whether interior or corner lot. ~ Premises known as "Lot No. 15 Laurelwo~ Estates''.:~ at Laurel Town o£ Southo:ldo Suffolk County, N.Y. STATE OF NEW YORK, t S S COUNTY OF ...S~f£.~l~ ............ f' ' r .......... gl~.¢,.r.t;..j~t....G~amaa ................ ~ ................................ being duly sworn, deposes and says'that he is the applicam (Name of individual signing:contract) above named. He is the ................... .0..ty..n..~.~...~Jl.&...C.~t,~.~.~.t,o~¢. ........................................... .:. ............................................................... (Contractor, agent, corporate officer, etc.) ~:][~l~;~l[~[~Xgt'~ts'~ 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 that the work will be performed in the manner set forth in the application filed therewith. Swo~ ~,o before me this ~j~,,,~ ~ ,~ ........................ day o ........................... ' b._ -x- u ....." ' Notary Public, ....~ ...................... County ...~.~ .......................................... MADELYN THER£3A SE~iDLEW,SKI [a (,e)-~[ I'IOTARY PUBLIC, State of New Y0rk~-' -~ / No. 52-4521790 Qumlified in Suffolk ~ounty Commission Expires I~arch 30, 197~ OC pOW Lo? 14 fmme t ~he fac~iit tnsp~c to be COUNTY HEALTH DEPARTMEN~ qervices U~ter not to be of bs~by fo~ula or cons~ption by znfants under 6 mos. o~ age. ALDEN W YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR LI~UREL roan o~ ,.,eOUTHOLD SUFFOLK COUNTY, N Y YOU. NG & YOUNG, LAND SURVEYORS 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK FEB. 24, 19751 I "-- ~0 ' 7~ ' 88 GUARANTEED lO THE T/TLE GUAt?ANTEE CO. 5Y. IFFOLK COUNTY NArlOI~L BAN SEAL S~k NOT BE CONSIDERED ~ ~ A V~P TRUE COPY GUAPANTEE S SUFFOLK COUNTY ON MAY I~ tHE ~DCA~,ON OF WE~S AND CESS~LS ~WN HERE~ A~E F~O~ Fr~ 0 ~tJDVEY ~o~r ~_ ~_~ ~~ tc~_~ ........ LOTNO 15 fcartin 14 Lot FOR APPROVAL OF CONSTRUCTION ONLY DATE . HS REF. NO._ ,APPROVED_ .~' ~' SUBDIVISION MAP F/LED IN THE OFY'ICE OF THE CLERK OF ~UFFOI K COUNTY ON MAY l~ 1971 AS FILE NO 5§95 ROBERT G~ON LOT NO/5 I1,~~'~%~ ' ~UREL ' SUFFOL~ COUNTY, N YOUNG ~ YOUNG, LAND S~VEYO~S ~OO OST~NDE~ AVENGE ~V~AD, NEW YO~K c:~rEFEB24, 1976 ~ ~LE ] NO '~ ........ C I "= ~0 ' 7~'~ r F J ! '0 ~c~ 22. a,