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HomeMy WebLinkAbout15896-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16542 Date December 28, 1987 THIS CERTIFIES that the building ....I.n.g[r..o .u.n.d. p o o 1 a n d f e n c e L ' 1705 Laurelwood Drive laurel ocahon of Property ............................. House NO. Street ................ County Tax Map No. 1000 Section ...1.2. 7. ...... Block 05 ..... Lot I I Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .A p.r.i. 1...9.,.. ! .9 .8.7.. pursuant to which Building Permit No. 1 dated .... A..p.r.i. 1...1.2.,.. ! .9.8.7. .......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 ......... .I.n.g.rp. qn..d.~pool and fence as applied for. The certificate is issued to JOHN A. & MARGARET A. ROSE of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO, N822956 July 28, 987 PLUMBERS CERTIFICATION DATED: N/A Blli{ding Inspector ' ' Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15896 Z County Tox Map No. '1000 Sect,o.~....i.....'~...~. ........ Block ......C~....~.. ....... Lot No .... pursuant to opplicatio~l dated .... ~...,...~.. ................. , 19..~...~.., and approved by the V Budding Inspector. Building Inspector Rev. 6/30/80 FORM NO 6 TOWN OF SOUTHOLD Budding Department Town Hall Southold, N Y, 11971 765 - 1802 APPLICATION FOR CERTIFICAT5 OF OCCUPANCY Instructions A Th~s apphcat~on must be filled ~n typewriter OR Ink, and submitted ~. laJm~mma to the Budding Inspec- tor w~th the follow~ng,,for new buddings or new use 1. Final survey of property w~th accurate Iocabon of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept of water supply and sewerage disposai-(S-9 form or equal)· 3. Approval of electrical installation from Board of F~re Underwriters 4. Commerma~ bu~dmgs, {ndustna~ buildings, Mu{t~ple Remdences and stmflar buildings end ~nstaHa- t~ons, a cerbflcate df Code comphance from the Architect or Engineer responsible for the budding. 5 Submit Planning Board approval of completed s~te plan reqmrements where apphcable. B. For ex~sting budd=ngs (prior to Aprd 1957), Non-conform~ng uses, or buddings and "pre-exist~ng" [and uses 1. Accurate survey of property showing all property hnes, streets, buddings and unusual natural or topographic features 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 3 Date of any housing code or safety inspection of buddings or premises, or other pertinent mforma- t~on reqmred to prepare a certificate Addztzons $25.00 POOLS $25.00 C Fees: New Dwelling $25.00, Accessory ,$]0 00 Business $50.00 1. Certificate of occupancy 2 Certificate of occupancy on pre-exmtmg dwelhng $ 50. O0 3 Copy of certlhcate df occupancy $ 5 00, over 5 years 4.Vacant Land C.O. $ 20 00 5.Updated C.O. $ 50 O0 Date NewC°nstt'uct~°n ''1 '' OldorPre-exlstmgBuddmg .... Location of Property, !/. ~ O~'~. .. ~,~.. ~:, ~.~4~,5...." House No Street ' d Owner or Owners of Prope tV ..: ¢,J~' . County Tax Map No 1000,Section ?¢-~ ? ....... Block , ,-~."~. ........ Lot .... ~../ ...... Subdlws~on .... ! ...... Fded Map No .... Lot No ~../._~ Perm,tNo '(l~.~/% ~- DiteofPermlt · Applicant Health Dept Approval .. .Labor Dept Approval ................... Underwriters Approval , ~ ..... Request for Temporary Ce(tlflcate Fee Submitted $ · ,Planning Board Approval · ,. F~nal Certificate $10 O0 ..... LZ ,'. g D ....... Vacant Land Hamlet THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY B5 JOHN STRE£T, NEW YORK, NEW YORK 1OO218 THIS CERTIFIES THAT John &. P~ ~70~ L~urelwood Drive, L~urel~ DRYERS ~ I FURNACE MOTORS Pd?u~a A~JANC~ F~DERS RANGES OVENS DiSH WASHERS EXHAUST FANS TIME CLOCKS JNIT HEATERS DIMMERS SYSTEMS OF FEET 1 ~05 Laurelwood Dr. 11 Thru ced,f,cate m~t not be alter~ ,n any manner, return to the off~ce of the ~a~d tf ~ncorrect Inspectors may be ,denhfied by their credenha[s COPY F~ BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE AL ~ ~EU IN ANY ~HNEE. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~]r BE; JOHN STREET, NEW YORK, NEW YORK 10038 .... 22955 THIS CE~IFIE~ THAT Jo~ t~o~ 17ob Laure~w~ Drive, La~r~ ~ .Y, m the followlng locat,on, ~ ~,~.t ~ I.~ r~ ~ ~.d ~7 ~t,o. ~t~ Lot l 3 ~s exam~n~ on j ~ ¥ ~ ~ ~b ~l and found to be tn comphance utth the re~tutremen{s of tht~ Board FIXTURE FIXTURES RANGES [ OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPtlANCE FEEDERS TIMECLOCKS MULTI-OUTLET SYSTFJ~S NO OF t~ET SERVIC2 DISCONNECT R V i-4. o aw ~i.W.ii. S E i I DIMMERS A w G OF CC COND 4 NO OF HI lEG I. i C E 4 ~ohn RO~ ~~/~ l?Oo L~ur¢~lwood Laurel, I~.Y. ilV4~. G~AG~ Th,s ce~,ficote musf not be o}tered ,n o~y monner, re~urn to the o~ce of fhe ~ard J mcorred inspectors moy be [~enhfied ~y fhe~ credentials COPY FOR BUILDING D~PART~GNT THIS COPY OF C~RTIFICATG MUST NOT G~ ALTERED IN ANY ~NNER > OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITI0~A'L COMMEMTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND I' ] FRAMING REMARKS: INSULATION FINAL DATE INSPECTOR 765-1~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~]"~NAL REMARKS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765.1802 ..(~..I..~ .... 19~..q. Permit No. I .h'7 .$3.1{ .'~... Approved Disapproved ale .................................. (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Lt I .... _Z_.i!9 BLDG DEf'T TOWN OF SOUTNOLr~ Received ........... ,19.. a. Tins application must be ~ompletely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 premlses or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. ¢. The work covered by tins apphcation may not be commenced before issuance of Budding Permit. d. Upon approval of flus apphcation, the Building Inspector will issued a Bmldmg Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or an part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Buildmg Inspector. APPLICATION IS HEREBY MA~DE to the Building Department for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construct]oh of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply .wath all applicable laws, ordmances, building code, housing code, and regulations, and admit authorized inspectors on pr~m~ses and in building for necessary inspections. ~ ........ 4.~. s-. 7.q~.'£..-/?~..' ~ ........... (Signature of applicant, or name, ff a corporanon) I ....~.9~.. 3' ~rz~" .. .¥. ~.q.. ;..Y.~ ....... /Ts..~.~r.. . . ~ ~ FX t .~. . ~. . .~.,. x. . (m. ailing address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bufld¢ Nameofownerofpremises .. ~)./4~...~.,..'e....~.,qg~.~.i.{4~.T'....~..:...~..O~.7~'. ......... (as on the tax roll or latest deed) If~aff~nt is a corporatmn, mgn~ture of duly authorized officer. ...... (Name and tffie of co)~¥~a-te officer) -~ Builder's License No .... ~.~9. 7.. ~..~7'.~. ..... Plumber's L~cense No ...................... O~er Trade's License No. , Loeat,on of land on whmh p(oposed work w~I1 be done ..... 4.~ House Number Street Hamlet County Tax Map No I000 Sectmn ..... I.~.~ ....... Block .... ~ . .. Lot... ).~. ........ Subd~vmion ................................ Fried Map No .......... Lot .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Exmting use and occupanck. .............................................. ... b. Intended use and occupancy ................................................ 3. Nature ofwork~cheal~-~hlchapphcable). New Budding .......... Addition ........ ... Alter~lon Repair .... .~..'...~... Removal .............. Demolition ......... __.._ Other Work/ ............ (Description : .ap.. 4. Estm~ated Cost .......................... Fee ................................... I (to be paid on ~ing 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 rmxed occupancy, specify nature and extent of each type of use .......... 7. Dmaenmons of exmting structures, if any. Front .............. Rear .............. Depth ......... Height ............... Number of Stones .................................................. Dnnenmons of same structure with alterations or additions: Front ................. Rear ............ Depth Height Number of Stories · · · 8. Dnnenmons of entire new donstruction: Front ............... Rear ............... Depth ......... Height ' Number of Stones 9. Size of lot: Front .................... Rear ..................... Depth ................ 10. Date of Purchase ............................. Name of Former Owner ....................... 11. Zone or use district in which premises are situated ......................... ,, .................... 12. Does proposed constructno¢ violate any zomng law, ordinance or regulation: .... /~.O .............· · :a-,~t 13. Will lot be regraded ..... :~.O. ................... Will exces~ fillbe removed from premises: ~ 14. Name of Owner of premises .~ff.~... ~0,~.~. .... Address ...~]~4.k~ .~.../tr'.~;~. Phone No ......... ' Name of Architect ........................... Address .................... Phone No ....... .~.~ . · Name of Contractor ~t]..r?i7/~.t ~'.r..s.l Address . ~. ?..~..J'~.~/£. ~.. Phone No. ~.. ~.~ ~ 15. Is this property located withinl~0 feet of a tidal wetland? * Yeg ..... No .~. ~ · If yes, Southold Town Trustees Permitmay be required. PLOT DIAGRAM Locate clearly and distinctly a~ buildings, whether exlstmg or proposed, and, indicate all set-back dimensions fr property Hnes. Gtve street and ~lock number or desc~iption according to deed, and show street names and indicate whet interior or comer lot. STATE OF NEW YORK, COUNTY OF ........ ...... S.S .......................................... being duly sworn, deposes and says that he is the applic (Name of individual mgning contract) above named He is the ............................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file ~ application; that all statements contained in this application are true to the best of his knowledge and behef; and that work will be performed in the manner set forth m the application flied therewith. Sworn to before me thru ........................ day of ..................... ,19...