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HomeMy WebLinkAbout9331-z FORM NO. 2 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) N? 9331 Z Permission is hereby granted to: L.~...~.~..~. ......... ~? .......................... ~.~.~..~..~....t.~..~.z.~.~ ................................................................................... al' premiss I~t~~at 1~ ~ ~l~e~ ~ , pu~uont to oppllcotion~-doted ............................................................... and approved by the Building Insp~tor. ' ' ' FOGM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office ~ Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions I A. This application must be filled in typewriter OR ink, and submitted in, triplicate to the Building Inspector wtth the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, p'faperty lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposgl--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requiremen'ts 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 dnd condition of buildings. 3. Date of any housing code or safety inspection of buildings or prem',ises, 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 ,.q ........................................... .... ~.... ...... Old or Pre-existing Building ............................ VoLantr Land; ........................... New Building Health Dept. Approval ..~ ............................ Labor Dept. Approval '"i ............................................ Underwriters Approval .............................. Planning Board Approval ........................................ 1 Request For Temporary Ce~ificate ........................................ Final CertificateI tee Submitted $ ....~. ............................. Construction on above described buildin~ll applicable c~ocles and regulations. Sworn to before me this App I ica nt .~, :.., ~r,~ ........... I ........ ~FZ~'""~-~" ......... .~.. dayof ....C~......~..~......~..~...Z.Z .... (stam~p or sea~~ NEW ¥0RK E"S " THE BOARD OF FIRE UNDERWRIT : VEl ~; ~ BUREAU OF ELECTRICITY F '"' ' S5 JOHN ,STREET, NEW YORK, NEW YORK 10038 Da,. $eptember 27, 197,7,,' ~ .~pp.c.t,onNo. ony,,. 925804 ,,~P~9331Z ~ N 35?836 THIS CERTIFIES THAT o~ t~ e(~tr~c=~ equipment us described belo~ and interlaced by t~ applicant ~med on the a~ve application number in the ~remlses of HeathQr Pi.~ . Laur~t~ ~T~Yf Gruhill Home~, S~e~c~ Laure~wooo ~r , inthe/ollowinglocation; ~ B~ement ~ lstrl. ~ 2nd Fl. outside ~ s.ctio. ~., .~.~..a o. ~epte~b er ~ 23, 1977 und/ound to be in compllance with the requirements of this Board. FIXTURE :'ECE~TACLES[ SW TCHES { FmXTURES ~ RANGES {C00KtNG~ECKS { 0V~NS ' ~DISH WASHERS EXHAUST FANS DRYERS { FURNACE MOTORS { FUTURE APPLIANCE FEEDERS SPEClALREC'PT T,MECLOCKSl BELL lUN'ZH~AT~S u z-ou ET DIMMERS ....... ~. - s~sz~s , , I~T K ~I IO'm'I' ~ P__ O.AS "."" ' .A~T ' NO . A w.~. ~T. ~f ~T ,~.p~ 7R S..~T .~" ~ OF FEET A~T ...WA]~S . OTHER APPARATUS: 1- G.F.I. ,_ ,, l- smoke detector * Specialrecept~cles: 1-30amp. * 1-2#14,1-2#12:Future appliance feeders Surdl Elec. Co. Holtsvflle, N.Y. 11742 Lic. q21E Th~ certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors TOWN CLERK'S OFFICE ~UTHOLD, N. Y. I NSTP, UCTIONS a. This application must be completely filled in by typewriter or in ink and sabmitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedulb. b Plot plan showing location of lot and of buildings on premises, relationship to ~djoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, c. The work covered by th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant. Such perm 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 Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildm, g Department for the issuance 9f a Building Permit pursuant to tk Building Zone Ordinance of the Town of Southold; Suffolk County, New York, and Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, I~ousing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections., (Signature of appli,cant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contracl'or, electrician, plumber or builde, If apphcant ,s a corporate, signature of duly authorized officer. (Name and title of corporate officer) ?-£o- Builder's L,cense No .... Z..~.....C).....~......~......~.... ................ /~ Plumber's License No ...~...A..Z...../~..'.. ................... //--) 0 0 - /~ '7 - -7-- .~ Electrician's License No .~.--.~-.Z......-.~;.... ................ Other Trade s License No ............................................... ~M-- ~q. / .¢1 '~/~/,:~--~ ~" ] Location of land on which proposed work will be dpne. Ma[} I~o~,,~'../~/.~_~.,/4/4~.....~.~. Lot No ..... .."}.../.. ......... Street and Number ~ .~..~..~.~...?.....~..~..~/~T~,~....Z~...~....~....~....~._.~.....~....~...~....,~.. Muflicipality 2. Sta~e existing use and occupancy of premises and intended use and occupanc! of proposed construction' a Exis,ting use and occupancy b Intended use and occupancy ............................................................................................ property hnes Gtve street and block number or descr~phon according to deed, dnd whether interior or corner lot 3. Nature of work (check which applicable) New Budding .~.... .... Addit,on .................. Alteration ............. Repair ............... Removal ................ Demolihor. ............ Other Work ................................................. (Description) 4. Estimated Cost .~.7.~.~'.../.....~f.. ................................ Fee ~...?.....-Z. .............. Z ................................................... (to be prod on filing th~s opplicahon) 5 If dwell~ng, number of dwelling units .......... ~....Number of dwelling umts 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 D~mensions of ex~stmg structures, if any. Front .......................... Rear ................................Depth .............. Height ....................... Number of Star,es ............................................................................................................... D~mens~ons of same structure with alterahons or addmons: Front .................................... Rear ....................... Depth ................................Height ......................... Number of Stories ................................ 8 D,mensions of ant,re new construction: Front .... ~.~.z..~,'~. ...............Rear ..?.~..o~... ........... Depth~.~...~...~..~.. ~ Height ...~...¢ ...... Number of Stories ~ ........................................................................................................... 9 S,ze of lot Front .../../..&9 .......................................... Rear ..../..~....-7.~.. ............................ Depth ......""~....~....-[...~.. ............. 10. Date of Purchase ....................................................... Name of Former Owner ....................................................... 11. Zone or use distnct in which premises are situated ..................................................................... 12 Does proposed construct,on violate any zoning taw, ord,nanc;' ;'~ '~;;~12}i'~I ~ 13 Will lot be regraded .... .~ ........ Will excess fill be.removed, from pre_l:niSes: (/-~Yes ( ) No 14 Name of Owner of prem,sesC~'/../....~.....~....~....~...~........~...~...~.....~....~...~.... ^d~.~:'~-~'~'.~'Phono No~'..~....~....~...~../.f- ............... ^dd4re.~ ................................Phon. No ...................... Nome of Architect .... ., ........ .. ........ ~""- ~.?.g...2~-...--~.~..~. of Co,,racto d .ZM.. . ........ A Phone Z PLOT DIAGRAM Locate clearly and dishnctly all buddings, whether ex~shng or proposed, and indicate all set-bock dimensions fron show street names and indmat~ STATE OF NEW YORK, iS S COUNTY OF . .S.q~.~9 ].~ .............. .................. ?..~....t....I~cD.~D. PJ,.Q ..................................... being duly sworn, deposes and says that he is the apphcan (Name of individual slgmng contract) above named. He ~s the ............................. ..c..o...n.tr.~g.tA.Q~ ........................................................................................................... (Contractor, agent, corporate officer, etc.) J of said owner or owners, and ~s duly authorized to aerform or have performed the said work and to make and fil this application; that all statements contained in th'~s application are true to the best of his knowledge end belief; an ti,aT the work wdl be performed m the manner set forth in the appljcet4pn filedj6.erewith. Sworn to before me this ~--" ,¢/ ....... .~.~.1~.~ ....... day of ............ ~l.n.e ...... , 19.7.?... Nota.ry Public, . .............................. $.%l.f. fo.lk .... Coun~ ...... · .~.....././.- ................................................................. ~ ~ , .~J ~ ~ ',,,~ Q--.-/ ' (Signature of applicant) 'ELIZABETH ANN NEVILLI~ / NO1ARY PUBLIC, Sta~e of New York No 52-8Z25550, Suffolk ~P~ Term E~Dire¢ March 30, t~ountv ELL SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY 8 150 oo FD pIpF_ '8 DA~FU r~ AE,.~.U 'hq E 'D ~ AREA '+],'~TZS0 m' IN EXCE~c~ OF ~ F'I' N, 8 5' 0':/'50" V',/ c~7~ LAURELW00D DRIVE I10 C~O' m THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STAND- ARDS OF THE SUffOLK COUNTY NAME [ Gruhill Construclion Cot }. ~ I ~ADDRES3~56 Route 112 [ Medford, L. I.~ N.Y. 11763 FE LEPHONE: '7.~,,~ / ~ 2~ FILE NO LAURELWOOD ESfS SHOWN HER~0N F R 0 M T H E 8TRUOTURES TO THE PROPERTY LINES ARE FOR A SP~mFI~ PHR CtOLATION OF SECTION 720D OF THE NEW YORK STATE EDUCATION 8HALL RUN ONLY TO TIJE PERSON FOR WIIOM THE SURVEY I$ PRE- BEARING THE LAND SURVEYOR'~ INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDEEED ~q ~ COPY, GUARANTEED ONLY TO HAROLD F TRANCHON JR NY LIC NO 048992 PENN LIC NO 21115-E SURVEYED FOR LOT NUME~ER 21 EL~OOD MAP OF LAUR ESTATES SITUATED AT LAOREL TOWN OF SOUTHO~D- SUFFOLK COUNTY N Y SCALE 1" = 50'~ DATE 6- 17- 1977 FILED MAP NO 5~95 DATE 5-17- 1977 ~OOK NO LOOSE ,LEAF PAGE ' TL,~,~D SURVEYOR SUCC ESSOR ' T'~NY~31'?~:~?"i G. MEIER NORTH COUNT~]~]-I~Jt'~G '~tVER NEW YORK 11792 (516)929-46195 ALT 473- 3626 '~WELL (~NELL~ Pit,.E. (WELL~ IV)Ap ...%oo LAUREL. PA ~ Y--. IE, o oo (.~76,'~ LAURELVVOOD DP, IX/F_ '§ 110,oo' Fu DA"f U r"3 A~U ~3Eo LOT AREA 41,472~0 H F_ARE_,~ WAle. k:, iN EXC~--. OF ~ FT' ~ j PIPE DWELL (.WELL") S UF~-O LK COUNTY {DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF- CONSTRUC'ION ONLY DATE HS RP'F NO . APPROVED THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE VVILL CONFORM TO THE STAND~ ARDS OF THE SUFFOLK COUNTY DEPT OF HEALTH SERVICES t~IAM E DDRESS IELEPHONE THE OFF~ETS (OR DIMENS~0N$) SHOWN HEREON F R 0 M T H E S'fROCTLIRES TO THE pROFEi~rY LAW. GUARANTEES INDfCATED HEREON SHALL RUN ONLY TO TIle PERSON FOR WHOM THE SLIRVEY I$ PRE- PARED, AND ON HIS BE'~ALI: TO THE TtT~E g, OMPANY, ~OVERNMEN GUARANTEED ONLY TO HAROLD f' TRANCHON JR, NY LIC NO 048992 PENN LtC NO 21115-E .OE~ NO 77- 303 SURVEYED FOR LOT NUMP, ER 21 MAP Of LAURELWOOD ESTATES SITUATED AT LAUREL TOWN OF' SOUTHOL~D- SUFFOLK COUNTY SCALE 1" = 50' ~ FILED MAP NO 55195 F3OOK NO LOOSE LEAF FILE NO LAURELWOOD ESTS NY DATE 6- 17- 1977 DATE 5- 17- 1977 PAGE HAROLD IF TRANCFION JR PC LAND SURVEYOR SUCCESSOR I'0 WILLIAM G MEIER NORTH COUNTRY ROAD- WADING RIVER NEW YORK 11792 (516)929o4695 ALT 473- 3626 z t~lUE. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERV CES FOR APPROVAL OF CONSTRUCTION ONLY DATE : HS REF NO, ~ APPROVED DWELLINGS OCT ~u~ A~E~ ~ O' 5 STK '§ LOT AREA 4'h47~ .~ ~e-r. ~F~,R~r' WATE3Z ~e? ~'~ LAUP, ELNNOOD D~J,X[ F_ r,~ ~'~ o "VACANT" [ FINAL SURVEY 8-12-77 'DWELL (. VY E L L"'J THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STAND- ARDS Of THE SUFFOLK COUNTY DEPT OF HEALTH SERVICES NAME ADDRESS TELEPHONE THE O~PSET$ {OR DIMENSION'} SHOWN HEREON F R 0 M T H E STRUCTURES f0 THE PROPERTY LINES ARE FIIR A SPECIFIC PUR- ~W. GUARANTEED ONLY TO GUARANTEES {NOICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PRE PA°~-), AND 0~/ HIS BEHALF TO A VALID TRUE COPY. RIVERHEAD SAVINGS BANK THE TITLE GUARANTEE CO HAROLD f TRANCHON Jr, NY LIC NO 048992 PENN LIC. NO 21115-E JOB NO. 77- 303 FILE NO, LAURELWOOD ESTS, SURVEYED FOR LOT NUMENER 21 MAP OF LAURELWOOD ESTATES SITUATED AT LAUREL TOWN OF SOUTHOLD- SUFFOLK COUNTY N Y SCALE 1" = 50', DATE 6- 17- 1977 FILED MAP NO 5595 DATE 5-17- 1977 FSOOK NO, LOOSE LEAF PAGE HAROLDI F, TRANCFION JR PC. LAIND SURVEYOR SUCCESSOR TO WILLIAM G MEIER NORTH COUNTRY ROAD- WADING RIVER NEW YORK 11792 (516)929-4695 ALT ,473- 3626 ('A'P~OVED AS NOTED DATEr "~'~'~ ~-~ 77. 3. 4. 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