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Home My WebLink About9294-zTOWN 01: 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) N? 929~ Z Permission is hereby granted to: ~- ~ ............................ ~. ............................ ,~ .............. : ................................................................................... ~.. :-{:~ prem,~s I~ated at ...I~t..l~t....~~..~ ................................................................ ~ -~; ';..L..,~ ....................... ~.: .............. :~~..~t~ .........~ ......~,t, ............................. ~mo~6nt to application dated..................... ~...~...~ ............... , 19.,~., and opprov~ by t~e f/ ................. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.0o Date .(.C7. ~(J. 7. ............ New Building ..... ~ ...... Old or Pre-ex~sting Building ............ Vacant Land ............. Location of Property . !,~..~.0....~./'4..~.¢'.~.).~.0.0.~....~..~.t.~..~ .................... ~. ~ .eL, r..E.~ ...... House No, Street Ham/et Owner or Owners of Property . ~4~u'~ ............................ County Tax Map No. 1000 Section .//.,.'~.' ~.' ........ Block .... .~..-. ........ Lot.../~. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..,~.~¢.~..~.. Date of Permit .~/o~/~.~...Applicant .~'i~/1.~..! .f::).~....~..f)..~.(.~.~.3..~..p ....... Health Dept. Approval ....'7. ? .~".-.-~.1 ............ Labor Dept. Approval ........................ U nderwr~ters Approval . .~..~. ~ [ . ~.~.Z~. ......... Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . .~ .................. Fee Submitted $. {: .~ ....................... Construction on above described building and ~perm~t meets all applicable codes and regulations. Applicant .~.~. , , (~Z., ,/~... ~ ¢~" FOB,M NO. $ TOW~ OF $OU¥8OL~ , Building Deportment Torn Clerk- Office Southold, hi. Y. 11971 APPLIGATION FOR GERTIFIGATE OF OGGUPAN¢¥ Instructions A. This apphcation must be filled in typewriter OR ink., and submitted in DUPLIC.~TE 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 disposalw(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 cert~hcate 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 o 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 New Bqilding ..... .~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property .~.~.~..°.g....~....~.~.,~.~.a.,.b..e..~.~.....~...e..~.~.g.E..z3:. ......................................................... Subdivision ..~.~.g.T:..e...].W.9.Q.~..~.'.~.~.%~.e...s. .................... Lot No. ~E~ ....... Block No ............. House No ............. Permit No ..~..~.z~ ...... Date Of Permit ..~.~..~.e....~.....Applicant ..]~.g.~.9.~.~..s...~E.s...e..n3.,....~.~., ................... Health Dept. Approval ~.-.~.~.=.?.?. ......................... Labor Dept. Approval ................................................ Underwriters Approval ..~...~...;SJo.]..?..~.=~JJ.-..2.~.=.~.3)lanning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificatex .......................................... Fee Submitted $ ~.,.9.g ........................... Construction on above described buildin~per~t ~e_~j,~l~ppl~ ica~bl_~_ cTs and regulations. Applicant ..... ~. ~... 5 .T~.. ~..~.~7~.~i. ~.....~ ......... Sworn 'o before me this N-~--~/ Public -.?~~w'~,~.., County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ pti'[ 85 JOHN STREET. NEW YORK. NEW YORK 10038 Va~. October 27, 1977 ~PPtiea'ia~°'°nf'e930263 N 361784 THIS CERTIFIES THAT only the clectrlcaJ equipment ~ ~scrlbed below and introduced by the applicant named o~ the above appllcatio~ number i~ the premlse~ of Anton Deb~uyn, e/s Lau~eZ ~ooa Lane 900t n/o Peeon~e L ~el, mthe/ollo~mglocation; L,nent ~ ]~trt. ~ 2.d r~. OUTSIDE S~t~on ato~a ~t 18 FIXTURE : FIXTURES RANGES, , :OO~NG DECKS ' OvENs DiSH WASHERS t E~HAUST FAN~' 0~E~S RECEPTACLES SWITCHES INCANDESCENT FLUORESCENT vAm~ ~T K W ~T K W ~T DRYER~ FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'P?~ TIMECLOCKS BELL UNITH~ATER5 MULTI-OUTLeT DIMMERS AMT K W O1[ H P ) GAS H P AMT NO A W G AMT ~P ~t ~PS TRANS AMT ~ H P ND. OF FEET AMT WA~ ...... .... ~ 3 % ..... i ...... I I 2 12 4 20 i I ..... , , SERVICE DISCONNECT NO OF S ER V I C E '' METER l~2Wj[~ 3~3w~3~4w' N6'OF'CC COND J A'WG NOOFHIEG AWe NO OF HEUTRALS AWG ........ ............ OTHER APPARATUS: 2-GFCI ' 2-Smoke Detector ..... 1-~.5 KW Hot Water Heater ~ Joseph D. Mazzonl Tl l [/ 227 Waverly Ave. Th,~ cerfificote must no, be oltered m manner, return ,o ,he office o, ,he Board ,' incorrect. Inspectors m~ ~ SMBOIVISION MAP PIL~O IN ~H~ OFFIC~ OF TH~ CL~K OF ITHELOcATIONOF~SANOcEsS~ssHOwN"EREOflAeE~"ELo ! YOUNG & YOUNG / ~E ~~ FOR TH~NOE WILL I ~ - ~ ~ I~ 5,/~rr I 400 OSTRANDER AVENUE, RIVERHEAD, N~ YORK 1 ~LY TO THE ~RSON FOR WHOM THE I I TOWN OF ~/ITg~/ ~ LANE woODS/DE ~ATER S~- ~ ~ ~ COUN~ DEPARTMENT OF N~ FO~ APPROV~ OF CONSTRUCTI~ /~bot 19 THiS 3DNVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS ~JRVEY MAP NOT ~EARING THE LAND SURVEYOR~S INKED SEAL OR EMBOSSED SEAL HALL NOT BE CONSlDERI REVISIONS APt? . 5~ 1977 M~Y ~$~1977 MAY 27 YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN ~W: YOUNG~ HOWARD W. YOUNG PROFESSIONAL ENGINEER AND LAND SURVEYOR LAND SURVEYOR. N.Y.S LIC. NO. 12845 N.Y.S. LIC. NO. 4Sa93 SURVEY FOR: ANTOIV de BRUYIV ~ ELIZABETH ,4. de BRUYAI LOT NO IB,'LAURELWOOD ESTATES" GUARANTEED TO: AT L,aUNEL CHICAGO T'/I'LE /tVEUF?~zI~/CE CO TOWN OF SOUTHOI D SUFFOLK CO., N.Y. ~ SCAL~. /,, J DAT~ J = 40' I~At?. 28,/977 No. 7~- ti -- / '1 AP~OVED AS NOTED i' ¸7. t j t.~L4'l //, / ~ -L