HomeMy WebLinkAbout18064-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217999 Date MAY 4, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 935 LAURELWOOD DR. LAUREL
House No. Street Hamlet
County Tax Map No. 1000 Section 127 Block 07 Lot Ol
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 20, 1989 pursuant to which
Building Permit No. 180642 dated APRIL 21, 1989
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 DECK & GAZEBO ADDITION TO AN EXISTING ONE FAMILY DWELLING.
The certificate is issued to ROBERT & DOROTHY SHAW
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N066378 APRIL 12, 1989
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
•os>ts xo. s
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)
N°- X 8 0 6 4 Z Date ~.l 19.~..J
Permission is hereby granted ~ nC3.t.,J
to ...4-V.?^.~~...A,.....S~C.!~.~....5.71.4-;ka.!h>:7....:~r~~~Q(~N!71.....T..4?...~!:)............
U .
at premises located at ...../..e~S.. .S~r.S:tdd..~l^.~:S24Q1 .....\..~.!>w:.......~4e!:(,~eE.e'4 .
.
County Tax Map No. 1000 Section .~...a~..7... Block Lot No .
pursuant to application dated .....~.~rld . .c~4
. 19.A.9., and approved by the
Building Inspector. 9V
Fee S••*5~•:••
Building Inspector
Rev. 6/30/80
' TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOIITHOLD, NEW YORR 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY l!~~~~yy p
DATE .../1.': .
NEW CONSTRIICTION ..fC...OLD OR PRE-E%ISTZNG BUILDING......VACANT LAND........
Location of Property... ~~f.......!~+,ay.x~?ra... _ ~r1_ . _ _ _ _ _ _ ~ urt(, . _ _ _ . , _
HOUSE NO. Cf~,~d f/a,,,l STR~rrl HAMLET
n n ~J
tr ~ ppf
c 4
Owner or Owners of Property...
County Taz Map No. 1000 Section .~':~7.. Block .l_..._ Lot
Subdivision Filed Map ........Lot..........
Permit No_ ..........Date of Permit ..........Applicant
Health Dept_ Approval Underwriters Approval..__.__.......
Planning Board Approval
Request for Temporary Certificate Final Certificate
Fee Submitted: $
APPLICAN~?.~~~/. rG .li:~C'Y/.. ~
~ .
O 3~~~3~so
2~P ISo~~ti as'
~ ~~yqq
srsl~y
rev. 10/14/88
i.::LD I:.s: ~ .:u:; pu„TS ~ ,;~dw~+~cNr~
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FOUNDATIOi1 (1st) ~
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~OUNDATIO;J (2nd) m `
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ROUGH FRAME & 4
PLUMBIJJG
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INSULATION PER N, Y.
C
STATE EPJERGY
CODE _
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FI;IAL
o
ADDITIOiIAL COMMENTS: x ~
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST ~ ) ROUGH PLBG.
[)FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING ~ FINAL
REMARKS: ~~~-="E 111 a-P~~o ~
DATE T ~T INSPECTOR
_
THE NEW YORK BOARD Of FIRE UNDERWRITERS PACE a
].1'351(1' BUREAU OF ELECTRICITY
86 JOHN STREET, NEW YORK, NEW YORK 10038
Dese AFRI1, 12,1989 ApplieetionNo.onfile 61204389/99 N Ob63%it
TN1Ei CERTIFIES THAT
only ehs elsctrkd equlpmsnt v described FNdour and introduced by the epplicettt nomsd on the above sppllatlon number to the promieu of
OBERT 3HAA, LAUR6LMOOD DR1Vt: BOX 153, LAURF,L, N,Y.
in ekefo/loreinR kTC nt ? Ixt Fl. ? Ynd F!. OUT .Section Block Lot
'41X>F~R ~
uw exomined on ondfound to be in complisnceTrith the reyuirementx of thu Boord.
tIXANE A~ fYY1TCIM5 RXTURES COOKIrt6 dCK5 OVlNS dwt WASNNS lXNAUST FANS
tXt1tET5 NGNDlt[!NT F1U011ttClNT OTNEn NAT. K.W. NAT. K.W. AMf. C.W. AMT. K.W. NAT. N.P.
2 3 2
DRYERS RXINAGE MOTORS JUAN! APlUANCE ttEDERt SNCIAL tlEC'/T iUSE CLOCKS ~ U/Ri IN~iNf MUIiFOUi{ET dMMEts
ANC N. W, pl N r. OAS N. r. AMT. NO. A. W, c. AMT. AMr. AMT. AMrt. TRANS. AMT. N. r. ND
p~jpT ANr. wAm
fERVICE EN~NtNCT S E R V I G E
AMT. NY. TrPt pM j. I p re t w Jw a i aw t.t'.w "0~ at~rca+o. w cC
c°' o. No. or N.uo a~X1'1!G NO.OF NEUTKNS or 'r~4nciN
ontRR AnrARATUS:
G.F.C. T:-1
~a~
JAMES HURRAY 1.IC.~3653P.
P.0.00X 305
[,ABRBL, NY, 1.1948
11
Per `
ThG arfifitaN mwt not 6e oXered in aq momwr; return m tM office of tM Eoard.if incorrect: Intpettort. moy be idsntffNd ~ c iak.
COPY FOR WILDING DEPARTMENT. TNIS COPY OF CERTIFIf:ATE MUST.NOT i~ ALTERED IN ANY MANNER.
BOAFD OF HEALTH
3 SETS OF PL.1NS
FORM HO 1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDINGDEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N Y. 11971 NOTII'Y J-3+r~+~
TEL.. 765-1802 CALL
MAIL T0.
Eramincd . • -il , 19 $9. ~ '
y
\pproved .:Z~ 19 g9, Permit No ~ 8 ° 1v!-{'4..
DisaPProved ale D r~ 2 ~ ~ _
,
i t~
I ~j ~I
. R!'.~.°.''.~... .
(Building Inspector) BlDO. DEPT.
TOWN OF SOUTHOt.D
APPLICATION FOR BUILDING PERMIT
Date . . 15 . .
INSTRUCTIONS
a. Tlus apphcahon must be completely filled m by typewriter or m ink and submitted to the Building Inspector, with -
se[s of plans, accurate plot plan to scale. Fee according to schedule
b. Plot plan showing location of lot and of buildings on premises, relatmnship to adjoining premises or public street
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apph
capon.
c. The work covered by this apphcatton may not be commenced before issuance of Building Permit.
d. Upon approval of this apphcatton, the BuIldtng Inspector will issued a Building Permit to the applicant. Such perms
shall be kept an the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or to part for any purpose whatever until a Certificate of Occupane;
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Peniiit pursuant to th.
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o.
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, budding code, housing cod ,and rem lotions, and tc
admit authorized inspectors on premises and in building for necessary mspecti~~~~-~
G..
99 nature of applica/nt, or na , if a corporation) .
~j3 u arc/w ~.o d L. u.~t . //P'f6
• (Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
..........O.~h cr:...............................................................
Name of owner of premises ...':.(.r.m~€~"~.`~.y!"~~~~.•-`!-1`k~'!••--••-.-.....
as on the tar roll or latest deed)
tf applicant is a corporation, signature of duly authorized officer.
(Name and title of co,~r!p; orate officer)
Builder's License No. 4/. ~~!Pr; .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
I. Location ofQlagnd on which proposed work wilt be done./ .
I{ouse Number Street Hamlet
County Tax blap /No 1000/ Secti1on /f.~ Block ,!J , , ~ , , , , , , • Lot ~ J........... .
Subdivision havl:Bl4 ...~T~.~~ Fded btap No. ~ Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction
a. Existing use and occupancy ~f! F„ /~~"/.'~1~~9...../j.....~
b. Intended use and occupancy ......~4fC.. • • • •~d•9`~• • f , .(a R~3.~ : .
3. Nature of work (check i~ filch applicable) New Butldmg Addition Alierauon .
Repair Removal Demolttton Other 1Vork , .
(Dcscnpuon
4. Estimated Cost [,t /oa .Fee .
(to be paid on Glmg this application)
5. If dwelling, number of dwelling units Number of dwelling units on each I1oor .
If garage, number of cars .
6. If business. commerctai or mt~ed occupancy, specify nature and extent of each type of use . .
7. Dimenstons of extsttng structures, tf any Front Rear Depth .
Height Number of Stones r~-...... .
Dimenstons of same structure with altcrattons or additions Front Rear
Depth Iietght . Number of Stones .
Dimenstons of e e new construction' Front Rear Depth . , , .
Het~l Number of Stones .
9. Size of lot. Front ....~.f° Rear Depth . ~mO .
10. Date of Purchase ~f
i~ ...l.Ylf Name of Former Owner .
11. Zone or use distract m which premises are situated .
12. Does proposed construction violate any zoning taw, ordinance or reGUlation. .
13. 1Vil1 lot be regraded .1Vt11 excess fll be removed from premtses• Yes
14. Name of Owner of premises :/<o~t~~, .~1h.4:•:.... Address ~e f °r/ Phone No. ~~{J'..
Name of Architect ...........................Address ...................Phone No.... .
Name of Contractor ..........................Address ...................Phone No .
IS.Is this property located with in 300 feet of a tidal wetland? *YES.... 10....
*If yes, Southold Town Trustees Permit may be required,
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate ail set-back dunensions fro
property fines. Give street and block number or descnptton according to deed, and show street names and indicate wheth
intenor or corner lot.
STATE OF \E\G' YORK, S.S
COUNTY OF .
• - • • • • being duly s~vom, deposes and says that he is the applicat
(Name of mdn'idual stgnmg contract)
above named.
[ietstfie
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and a duly authortzcd to perform or have performed the said work and to make and file th
apphcatton, that all statements contained m thu apphcyhon are true to the best of lus knowledge and belief; and that tt
work wd[ be performed m the manner scI forth m the apphcatton filed therewith
Swotn to before me this
...............a.~......dayof 19~~
~otary• Public, / 1 vM'
~':.~:~.".':`~.I.L....klL,(~d~;...... County 1
HELEN k OE YOE • H?....... . ~ .
NOTARYPUBlIC,StateolNewYork ~narureofa hcan
No. 4707878, SufiolY Counb7 ~ i~ PP
Term Expires March 38, la_-.~-/
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