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Home My WebLink About8031-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z6976 ....... Date ............ April...16 ..... ,197~. THIS CERTIFIES that the building located at .~ ])e~.l)~ive ........... Street Map NoI~ural .C.t~ .l~lbck No ........... Lot No, . 2[~ ...... I~.el.. N,Y, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~T~e.. 3019 .?~. pursuant to which Building Permit No..8.0.~.].Z.. dated ........ Jlh'le. ~.C) ......, 197~'.., 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 .P~'~.a$.e..o.l~.e.f.~..m~,~ .d..~.e.~.l. ~.ng ....................................... The certificate is issued to . .~n,~cl. Hol~ea .~lle ....... .~,~x' ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval S.e.p~...~.$...~.?~...b. ~;R.,...V~.~.l.a. ..... UNDERWRITERS CERTIFICATE No... N2.~059...Sept .1 $,: [197~. ....... ~ ....... HOUSE NUMBER ...~9.~. ...... Street ... l]e~ .D~'~r® ........................ Building Inspector( FOF,~I 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) Ne 8031 Z Permission is hereby granted to: ~,~ttz ~uok to ~kz.~.. ~..e.~....o.~... La.~..x.,z.~%~. ~.e..z...z.~ ...................................................................................... at premises located at ......~..o.~,..~...~.......~..a.~..e.~..,~i,!~.~..~.~'....~.t~.,t,.~,,~.e..~. ............................................... ............................................... ~ ?.,.,~.~...~). ~.;L .v.~. ........ .L ~.eJ, ............................................................ pursuant to application dated ........................J-lal~......3O ............. 19.~..~..., and approved by the Building Inspector. Fee $..6. ~..?.2. O. ........... 2B6 FOl~l NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY InstrucHons 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: ]. 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-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 D te ........... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.~.~.~.~.~..~..8..~.~.a:.~...~.~`.~C.~.~..u~.~.~.~.~.~.~..~..a..`?~`~.~.~. ...................................... Owner Or Owners Of Property .~..~..~..&...~..~.....H...o~..e...s.~....~...~..~..,. ........................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No....3...8..~.5... p .... 8031Z 6/30/75 .,Z.. ,~.,, ,I~.~...H...O.~.~..~.... ~.NC.... ...................... erm,r p~o ..................... Date Of Permit .................... Applicant 5-S0-86 9/16/75 . Health Dept. Approval ............................................ Laoor Dept. Approval ................................................ lxi~2~6089 9./.Z6/-75 ---:n- ....y...e.~ ............................. Underwriters Approval ........................ ' ..................... PI~.., ~ Board Approval Request For Temporary Certificate ........................................ Fin(~l Certificate ¥e$ Fee Submitted $ .5.00 App lico r~~~~jvl~.~.. · ZDiC:.; ............ Sworn to before me this ................ day of ............................................ (stamp or seol) Nota~ Public .................................... Cou,~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant--S41) ~, Address ~,t~, ~ -z~ 2, Property Location ~)~ Village ~ Township.~t~o~ 3. Public Water Comp~nJ/_ Name 4. Lot size: Width ~J feet Length feet 5. Subdiv~m~lmm~ 6. Section 7. Lot Number ~ 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: Precast ~ .Equivalent Block B. Leaching pools: Number of pools o~ Precast ~ Block __Special__ ll. If p~.te well, fill in the fol- owi n~J~j~l anks: ~ Tan"~capaci ty 4,~ gallons }~! To~~' well depth ri0 Depl)~Sto ground water 4~D ~ Amo~ of water in well~l~J The undersigned CERTIFIES: "Construction of authorized installations w~ll be in accordance with the Suffolk County Department of Health Services' current stanOards 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. DateJVn~l~ 25~ 1~7.~ Signed FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed~oJq this plot. S-15 Rev. 4/1/73 BUREAU OF ELECTR!C:)? ¥ Inlaad Horxes, Job ~236 -De.ar ~. ~urel, L.!. , , . 1 3 t8 ~ 1 , NOTE¢ MONUMENT UBDI IllS~ON ~4A P FI£ £D ~IV THE OFF/CE OF THE CI-£RK OFSUFFOI. K COUNTY 01¢ JUNH~,IgZOASFI£ENO. ~486. YOUNG & YOUNG 4.00 OSTRANDER AVENUE, RtVERHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOUNG SURVEY FOR: RICHARD RYAN 8, FUJIKO RYAN LOT NO. 28,"LAUREL COUNTRY ESTATES" AT LAUREL TOWN OF SOUTH OLD SUFFOLK CO., N.Y. SCALE: j,, : 40' IDATE:oC-T. SJ, iN~Ji TY CO. REV,S~'WS YOUNG & YOUNG AU~. 7, 1975 400 OSTRANDER_AVENUE, RIVERHEAD, NEW YoRK SURVEY FO~,- - INLAND HOMES~ INC. LOT NO. 28,"LAUREL COUNTRY ESTATES" SOUTHOLD ~ ~ ' :'::' '~:',~ ~"?. SUFFOLK CO,, N.Y. .'~ INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~ Inspector, with 3 set~ 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 adjo n ng. prem sas or public st.reets of .~ areas, and giving a detailed description of layout ofproperty must be drown on the diagram whmh is part of this appl,cation. ~ c. The work covered by this application may not be comment;ed before issuance o~ Building Permit. d. Upon approval of this application, the Building Inspector will issue'a Building Permit to the applicant. Such permit ~'j 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 granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the t~ i~uildlr~.. Zon,e O.r.dinonce. of .the T?,wn ,of. Southol.d, Suffolk County, New York, and other applicable Laws, Ordinances or ~/ egu arians, tar me consrrucnon or ouilaings, additions or alterations, or for removal or demolition, as herein described/v The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature Of applicant, or name, if a corporation) Box 1~7~ M&~itu~ko N.y. 119S2 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Gene~:&l Con'l:~:&c'to~: Name of owner ,. ......................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... S...3t?...-..~.. ................................... 273-R Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... "o La~el C~un~ 1~-' .~: 28 1. Location of land on which proposed work will be done. Mop ~ .: ........................................ EOt No ......................... Street and Numl~r De2311al~ D~ives L&ul~el Municipality 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................ .V.~.~..~. .......... .. . . 1 - ~a~il~ b. Intended use and occupancy .................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 5 ~..... (Description) 4. Estimoted Cost .~.~.Q...C~...e..O...O. ...................................... Fee .~'.. ..' ............................................................... '(to be paid on filing this. application) 5. If dwelling, number of dwelling units ..... ~L .................... Number of dwelling units on each floor ............................ If gorage, number of cars 3- ...................................................... ~ ................................ 6. If business, commerciol or mixed occuponcy, specify noture ond extent of each type of use ............................ 7. Dirnensions of existing structures, if any; Front ............................ Rear ................................ Depth .................... Height .... : ................ Number of Stories ;: ............................................................................................................. Dimensions of some structure with olterations or odditions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .6..~ ....................... Rear ......... .~.~ .............. Depth ...29. .............. Height ....... 3,.~. ........ Number of Stories ..... ~ ............................................................................................................. 9. Size of lot: Front 3.30 Rear - 130 Depth 190 10. Date of Purchase ............................................. ; .......... Name of Former. Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~9. ................................................ 13.' V~ill lot be regraded ~..e...~. .................... Wil excess fill be removed from premises: ( ) Yes (x) NO 14. Name of Owner of premises .~.3:..?...~l.,..H..e~...e...s..~....~..~..~..~. ........ Address ~.!~.7......1~...~.:.. Phone No 298-g696 Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~....H.~.~......3~..~... ............... ~o~ ~- Address ................................ rflofle"mo ....................... PLOT-DIAGRAM L6cate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-ba~F,, dimensions from property lines. Give street and block number or description according to deed, and show street names and'indicate whether interior or corner lot. ..................... :.....~....~.T.: ................ being duly swgm, deposes and soys thath~r'the applicant (Narn'e~of individual signing contractO ' above named. He is the ......................................... ~ ........ ~~ ............................................................................. (Contractor, a~t~,6~porate officer, etc.) of sa d owner or owners, and is duly authorized t~er~orm Or have performed the said work and to make ond file this application; that all statements contained in this application' 'are true to the best of his knowledge and belief; end he manner set forth in the opplication filed therewith. that the work will be performed Swom to before me this /~ ........... of ..... Notary Public, . .............. ~C...~.~f.. Inland Homess Inc. APPROVED AS NOTED DATE: '~Ol'J~' ~,~ ~ ~' ,,IOIIEY BUILDING DEPARTMENT AT / 5-266U 9AM TO 4PM FOR REQUIRo ,,..+,. uP