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HomeMy WebLinkAbout13127-zFORM NO. 4 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13053 Date December 12 19 84 THIS CERTIFIES that the building ....N.e.W..D.w.e.1.1..i.n.q .............................. Location of Property ...2.4. .8 .5 ................ .D?.l.m.a..r..D.r... ............ .L.a,u?..e,Z ......... House No. Street Hamlet County Tax Map No. 1000 Section .... l. 2. .7 ..... B]ock ..... 0..4 ........ Lot .... q 0..3 .......... Subdivision ....... .X ....................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~.p~./,l~...4 ......... ,19 ~.4. pursuant to which Building Permit No .... ~..3.Z.2.7. g. ........... dated ......... ~.a7 .... 1..5 .......... 19..8.4, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... New Private One Family Dwelling The certificate is issued to HAROLD H. hTHELAN ..................... ?o;4,,'o;. ¥~d~,.'t~;~ ...................... of the aforesaid building. Suffolk County Department of Health Approval 14- SO- 6 3 UNDERWmTERS CERTIFI¢^TE NO ..................~.6.7PA6.2.... ~ .................... Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13127 z Permission is hereby granted to: .................. .~.~ ..i~~.~.'.-..-,.i~,:1.....'~ .............. ............. ............... :.l., ....................... ,o....W.....q ...... .~...~%.~.~.....r,,....~,~.~..'.i~..~J~L~ ~.....~L¢~..~g ,~,~..,. .............................. :..:;?...:::: ....... .: .......... .:::: ............. ; ................ /:,, .............. ;,;. ................... at premises located at ..... ..~ .................. ~ ........ .~.,....~..b ,~....~..~q,..,....~..~ .................. County Tax Map No. 1000 Section .... .J....'.~.....-7.. ....... Block ...... .~..~. ........ Lot No ....... :,~.~.. ............. to application dated .....~....~......L~../'% ' ' ' ............................... , 19~.~.t..,--' and approved by the pursuant Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 featu res. 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 [nf0rma- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copv of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. ~~, Date .... /..: .-~. ~. ~'. ·... New Building . .~ .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...................... ; ................ House No. Street Ham/et Owner or Owners of Property/~..~.~.~',~. ~-/ ~/~,~/~/~T~,~/ . County Tax Map No. 1000 Section .... ./'..~...~. .... Block .... ~..~. ..... Lot...;~ ........... /~o~ ~ .. Health Dept. Approval - Labor Dept. Approval Underwriters Approval ................ Planning Board Approval .................... Bequest for Temporary Certificate ..................... Final Certificate .................... Fee Submitted $ 5,~', · ........................ Construction on above described building and perrr~ meets all applical~le codes.end, regulations. ~9-~' ~3~' '~' \ Applicant ~-.~~~.. ~. · .'~. · .~.~.~. "~ .~-.-,-?~J.....~/.~ . ~.....~, .~.~.. ~ .......... Rev, 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit ~ Owner/~) /"/- ~f~/,,~L-~,~,~/ (please print)~ Plumber ,Z[//~,O','~' ~ /~'43~~> ~''''~* (please print) / I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. signature) ff Sworn to before me this /~/ff~ day of ~~g~ , Notary Public, .~/~/~ County THE 1984 NEW. YORK BOARD OF FlEE UNDERWRITERS 85 JOHN ~EET, NEW YORK, NEW YORK 10038 [COOKING DECKS OVENS I D~H WASHERS E R V F©UNDA'i ~OU (P_nd PLUMBING 7N~U[,A ~ION FER N. Y. STATE EN EF, GY C,ODE ADDITIONAL COMMENTS: 7GS.1802 BUILDING DEPT. INSPECTI,ON [ ]FOUNDATION 1ST [ ] ROUGH PLBG. ~ [ ] FOUNDATION ;~ND ~)~ INsuLATioN [ ] FRAMING [~] FI~ REMARKS: ~ ~ -'-.~.~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Approved .... . .~...a~. !.~.., 19~2~'. Permit No. t~. t.&-..~. ~. Disapproved a/c ..................................... Received .......... ,19 (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 sets 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 adjoining premises or public streets or areas, and givhig a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit 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, t~or 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 building for necessary inspecti2p,~. ., ~--,J ~-r,t J (Signature of applicant, or name, if a corporation) .oE'..~.o...~..*.-.~.4 ~.,'q .,.,,4.. ~.&. .... ~..~.. ~ (Mailing address of applicant)/,j State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .c?..~. ~.& ............................................................................ N~,,e of owner of premises.../'(.'¢.~q.< ~..~.. :.add?..z..'q~ ........................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..'7 ........................ Plumber's License No. -- Electrician's License No. -- ... Other Trade's License No. - 1. Location of land on which proposed work will be done .................................................. .......... 0.. q. ......... ,e. .... ........ ................ House Number Street Hamlet County Tax Map No. 1000 Section .... ./..~.7. ........ Block .... .O..~. .......... Lot....~. .............. Subdivision . . .~.. k{--.~'7. Z....~.t+..,~..7~..~. ~,4:..T-.~.~... Filed Map No...~'~.z/{.~..~. ...... Lot . ../..ff. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ,~.~.ff//,)~=,'¢d.27`.~t~t~-'. ................................. 3. Nature of work (check which applicable): New Building ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work .............. (Description) 4. Estimated Cost . ."../7(.O.i.q.°.O. ........................... Fee ...................................... (to be paid on filing this application) 5. If~lwelling, number of dwelhng uhits ............. 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 structuresI if any: Front ............... Rear .............. Depth ............... . Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... '. Height ................... Number of Stories ...................... 8, Dimensions of entire new construction: Front ..... ~ff. ........ Rear ...~'~'. ......... Depth ...~.. Height ............... Num6er of Stories ...... ./.. ~ft~.i.~. ........................................ 9, Size of lot: Front ..... ,/.~t.O. ~] .......... Rear ........ /.~?.' ......... Depth .../.5'~.' .............. 10. Date of Purchase ......... ~./~... · . . ~ ........... Name ~of Former~Owner ............................. [ 1. Zone or use district in which premises are situated.. ,~.q'%.~/. ~O,~'. 4~ ?-~.d~. ............................... 12. Does proposed constru?~..n_ violate any zoning law, ordinance or regulation: .. ~ .,~.~ ............... ~ ...... [3. Will lot be regraded ...V.~..~".... i ...... ....; ........ Will excess fi].ll be removed from premises: ~ No [4. Name o f Owner o f premises-~/~ .~]O~..~. ~...~Jfl..~'./r~.a/Address ,5~'-~.o. ~ff~ O~ t. ~ . .~..Phone No. ~,57'. ~ 7..~. ((~ . Name of Architect ~O~]'~.~q~/'OD..~.~1% .~..~.. ..... Address ....'5/~..~J~. ~ .~:~... Phone No. /g?O;.ff?}. ~. ..... Name of Contractor ......... ! ................ Address .... ~(.y...4/. ?~. g.. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from )roperty 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 YORK, COUNTY OF ................. ............................ , .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigrling contract) He is ............................................... · ~ (Contractor~orporate Officer, etc.) of said owner or owners, and is dffly authorized to perform or have performed the said work and to make and file this application; that all statements contained in tliis application are true to the best of his knowledge and belief; and that the work will be performed in the mann0r set forth in the application filed therewith. Sworn to before me this ............. ~. ~ ...... day qf .... t~/j/~Ad~.. .......... 19 .~..~ Nbtary Public ........ ~ o~. .... Count HEt ~],1 K. DE V0~ " ........ NOIAIIY P[iBLI(~, Stat0 6f hew Y0rl~] (Signature of applicant) N~, 47071178, Suffolk Cm~nty " · j05 SINGLE FAMILY DWELLING ONLY SU~Y FOR HAROLD H. ~HEL~N ~F~K CO~;d¥ ~.~., .. ~/..~ 0:~ ~:~:.;J-~'H S~V~C.~. LOT NO. I~, "LAUREL COUNTRY ESTATES" FOR /,PPt~OV/:.L 0~: '~'C);q:T~':~UC~;()h~ ONLY ~N ~ ~U~O&D SCALE: / "= 50' ' '- .............. ~ ~U~H~tZEO ~L~[~T~ O~ ~OmT~O~ ..... . -- NCOPIES ~ ~IS S~VEX NOT KARNG THE ~AND AM~BICAN ~/~~. HEALm DEPARTMENT-DATA F~ APPRO~ TO C RUC T Arno ~ ~ ~.ALF ~ t,E TITLE C~Y, OTHER THAN TflOSE SHOWN HEREON. OWNERS , WIk~C~FORM ~ T~E STAN~ OF T~ SU~K CO~TY DEPARTMENT TOEXI~TING STRUC~R~S ARE FOR A SPECIFIC OF H~LTH S CE~, PURPOSE ANO A~E NOT TO BE USEO TO ESTABLISH g.y, r¢?-//?f YOUNG S YOUNG OS NOERAVE E RIVER~AO~ NEW YORK NOTE: ~ : MONUMEN~ ~ = ST~KE AL~EN W.~UNG~PROFE~IONAL ENGINEER ~U~A/V/~/~N MAP F/~ IN ~ OF~/~ ~ ~ C~ ~ AN~ ~ND SURVEYOR N.Y.S. UCENSE NO. 12845 ~FFO~K C~N~Y ON dON~ ~, 19~0 AS F/L~ N~ ~$. HOWARD W. YOUNG, ,LAND SURVEYOR ~ L~T~ ~ ~L(W).~IC TANK{S~aCE~S(~)~ ~E~ N,~;~. LICENSE N0.4589~ ME m~ ~1[~ ~MTI~I ~ OR OATA OITNKO v~ OTHERS , ,h~, BRANDIS & SONS INC, 1046 ..... \ £ ~ ' F/tie No. 07-105964 LOr NO. I~, "LAUBEL COUNTRY ESTatES" AUGUS~ Z~ 19~ AT LAUREL DATE: MARCH ZZ, SUFFOLK COUNT~, NEW ~K .o. e~-~/9 HOT B[ CON~IDE~D TO B~A VALIO TRUE COPY HE~ DEPARTMEnT-DATA F~ APPRO~ TO C~STRUCT ANO ~ ms ~F ~ THE ~TCE c~v, ~OV~N- MNEAflESTW~IAI~[,~ flSOUflCE~WATER, ~I~TE~P~IC~ ME~TAL~AG~NCYANDLEN~INGINSTIT~TION LIS~D M ~CO. T~MAp M~T/~ SECTION /~ ~K ~f LOT ~ H~E~,~0 TO mE ASSIGNEES Of THE CENDING OTH[~ THA~ THOSE S~OWN HEREON. ~ ~TO A~ITI~aL INST~TUTi~S OR SUBSEQUENT oWNER~ ;' ~ NO~ · : ~ONUMEN~ ~ : ST~KE ALD W.~UNG, PROFE~IONAL ENGINEER ~/W~/~ WA~ ~/L~ /~ ~ ~/~ ~ ~ff~ ~ ~ AND ~AND SURVEYOR N.Y.S. UCENSE HO. 1~84S HOW~RO W. YOUNG~ LAND SURVEYOR ~ C~ ~CIW),~C TA~KIST)~ CE~OLS(~) ~N ~RE~ N.Y.S~ LICENSE N0.4589~ BRANDIS & SONS iNC, 1046 ; / NOTIFY BUILDING OEPARTN~N--T'AT 765-1802 E AM TO 4 PM FOR THE FOLLOWING INSPECTIONS. ]' FOUNmA¥10N TWO REQUIRED FOR P"URED CONCRETE 2. ROUGH ~ FRAMING ?, PLUMBING copper tubing is used [or water distributing system; piping shall be o} types K or L only PLUMBEt2 CERTIFICATION ON LEAD CONTENT BEFORE CE~TIF~A '~ ~ OF 0¢, C U,P/~We~ L