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Home My WebLink About8191-zTOWN OF SOUTIIOLD BUIM~G DNPARTMENT Tovm Cl~'s ~ $,,,~ola, N. Y. Certificate Of Occupancy ~ap No ............. Blor~ No. ~ ....... I~ No .............................. conforms substantially to the Applicaito~ for Building Permit heretofore ~ed in this office dated ..........~..1~ .P..~....!.,0 19 ??..~' Pursuant to which Buildl-s Permit No.~. ! ..?.1...7--' dated .......... .~.E...~.7. !.0., 19.7.~.~., was issued, and confonhs to all o~ the requh~ ments of the applicable provisions of th~ law. The occupancy for which this eoritl~te is (ownor, of the aforesaid buildinS~ Suffolk CoUnty Dep~-tm_~ t of Health A~r~val IJ31DER~,IT~ C~It~'I~.'I~ ~o ............................................. aous~, mm ........ ~4 o ~.~ ..... .~ ~. ~..[ ~ .~.~ .... ~: ~ .t: ....... .................................................. . ,k.~. ct .t'~. t5 I~. ~...,~....' i ..... ..... ' B~l~tng hu~-etor I I~OB,~ NO. ~ TOWN OF .~O~JTI'IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8~.9~. Z Date ............................ .~..../.'..~...., 19.17...~.. Permission is hereby granted to: ~.:.L:?.:~ ........ /.~.Y~..~ ...... ~ ............ ~/~_ ~/ pumuant to application dat~ ~e ¢5 t ~ 19.~..~., and appr~ by the Building Inspector. .............. Building inspector #240 FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment 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 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, unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, ,%4ultiple 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 Date October 22, 1975 New Building ................ Addition .~, ..... {~er Pre-existing Building ..~ ....... Vacant Land .............. Location Of Property Corner of Emma Drive & Delmar Drive Owner Or Owners Of Property Mr. 3ohn Canu Subdivision Laurel Country. Estates Lot No. 29 Block No ............. House No 4045 · 8191Z . 9/10/75 . Inland Homes~ Inc. Permit No ..................... Date Of Permit .................... Apphcant ................................... : .............................. Heo th Dept. Approval ..~.~..o..t.....n...e..e..d...e..d. .................. Labor Dept. Approva ..................~.......I.L ................ ~d ~'r.~971~-- . ............... Underwriters Approval ............................ /.~'....~L../..~>lanning Board Approval ......... ~/~-'~ . Request For Temporary Certificate ........................................ Fined Certificate / Fee Submitted $ .5......0..0.. .......................... Construction on above described building .a~'~ a. ll~c~l, icable, fodest'x/~ ~/~. ---L z.g ~'~ and regulations. Applicant ..................................................................... KENNETH W. Sworn to before me this ......... ...... Notary Public ....... ,~-~,i!. County THURBER -- IAq.AND HOMES, IVC. (stamp or sea~,~/tt_tt'O,~ ~ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 1OOSB ;'~i~ C~RTIF~ES THAT 5~RVICE D~.CONNECT NO. OF S E R V I [ , Elec.room heaters: 1-2.Skw, 3-1.25kw, 1-1.0kw, 1-.75~w ¢ (Building InspeCtor) ~' /O~.~v~'- - ~ ,~ APPLI~,ATIOfl FOR BUILDING PERMIT //'~/~, ~ ~ .................. , ...... a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ of ptam, 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicotie~. c. The Work covered by this application may not be commenced before issuance of Building Permit. I~ d. Upon approval of this application, the Build!ng Inspector will issue a Building Permit to the applicant. Such perm;t 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 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 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) (Address of applicant) State whether applicant is owner, lessee, agent, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature ~f duly authorized officer. (Name and t fie of corporate~ officer) Builder's License No ..................................................... Plumber's License No. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ...................................... i... L. ot No .................... . Street and r~um~er ............................. ;.~. ................................................................................................................... Municipality State existing use and accupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ................................................................................................................................ ~. Nature of work (check which applicable): New Building.. ............... .. Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior. .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ,~].O.~OQO~OO. .................................... Fee ................................................... J ...................................... (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 ...................................................................................................... ~ ...................................... 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 ........ ~.~.e. ......... Number of Stories ..............~ ................................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ......~..~. ....................... Height ........]:..8. ................. Number of Stories .....~ .......................... 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ..... ~III..~AII~.¢I~ ........................... Rear .............. .'. .......................... Depth ................................ 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: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ........... ~ ................................ Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contracto~,~...~a...~[J~ll~., .................... Address .~l~l~h~MIl~ ........ 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 names and indicate whether interior or corner lot. STATE OF NEW Y~R.I(~'/.~/~Z' ~SS COUNTY OF .~...f ' ............ ..~...~~ ....... !..~...!..~..?'..~ ........................... being duly sworn, d~os&s and says t~t he is the applicam (Name of individual signing contrac~ above name. He is the ................................................ ...~ ........................................................................................................................ (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have per~ormed the said work and to ~ke and file this application; t~t all statements contained in this application are t~e to the best of his knowledge and belie~; and that the work will be performed in the manner set fo~h in the application filed ther~ith. Swom to before me this ~ ~ ~ "~ ~ APPROV~ED ~S., N~OTED o^TE:V" /,~. FEE: /~ ~ NOTIFY BUILDING DEPARTMENT 765-2660 9AM TO ~PM FOR REQUlR. ~ ~D INSPECTIONS: ~BEFORE BACKFILLING r~ ~FORE COVERING PIPELINE ~ ~.~W.E. ~OB CO~,~T~ ~ ~._~ESP~BLE FOR DESIGN OR REVISIONS N0M 15, ]973 DEC 20,1973 SUBDI~ OF TH~ YOUN( 400 OSTRANDER AVE~ ALDEN W. YOUNG SURVEY FOR: INLAND HOMES, INC. LOT N0.29, "LAUREL COU AT LAUREL 'T OVEN- F~E- SOU FHOL O c ...."~' K CO N.Y,