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HomeMy WebLinkAbout6825-zTOWN OF SOUTHOLD BUILDING DEPAR'I'~fRNT Town Clerk's Office Southold, N', Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ...8.00. A.1.1~..D?.~¥9 ........ ~ Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .A.u.g~..s.~.....2.7. ........ , 19..7.~. pursuant to which Building Permit No ..... 6825Z dated 'Augur' · ' 27 ........., 19.75., was issued, and conforms to all of the require- merits of the applicable provisions cd the law. The occupancy for which this certificate is issued is .... 1~.iva.te. $na .F-m ~ ~y. i~ellin~ ................................... The certificate is issued to ......... John .E...Clark ............................... of the aforesaid building. Suffolk County Department of Health Approval November 6, ~97/~ 5-So-~5~ ............... Rbl~ez'*t' ~; 'Vt.:la' · · UNDERWRITERS CERTIFICATE No ..... N.~82865... Sapte~her..~. ~ 9.7./~ ...... HOUSE NUMBER ..... 800 ..... Street ............ Albo..lYriv. e .................. .................................................. Laud. el ,. H,Y, ................ uuilding inspector~ County Tax Number 1000-126-5-9 FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6825 Z Date ........................................................ , ] 9 ........ Permission is hereby granted to: ........... · T~xb.~. J3.~..C3 ~-tr ..................................... ~arllne La Mattituck to ...... E~.~...?**.w.....°..n.~...f.~E.~.~Z..~..'.~..~.E.~.~ ................................................................................ ot premises Iocoted ot ..**q/4L.../I,1]IO..A~B'~'Z~ .................................................................................... Laurel ~ .Y. ~ursuant to application doted ........................ .A..u..~ ............ .2..?. ........ , ~..?..~.., end approved hy the Building Inspector. Fee $9~ ..~.~ ............ Building Inspector 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 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 $5.00 Date . .D.e.c.e. ,m.b.e.~., .1~..]:77.8 ...... New Building X Old or Pre-existing Building Vacant Land Location of Property ,8.0.Q..A.l.b.o...I).~.~.e.,..I~.a.u..~.e.Z. ........................................ Houga No. Street Hamlet Owner or Owners of Property John g. and ?atr£cla A, Clark County Tax Map No. 1000 Section .... 1.2~ ........ Block ... ~ ........... Lot ..... 9. .......... Subdivision ...... -..- ......................... Map No. -- Lot No. -- Permit No..6.8.2.5.2. .... Oate of Permit 8../.2.7./.7..3..Applicant John E. Clark Health Dept. Approval .R.e..~..~f..3. .- ~.0.-.]~ ~[ .......Labor Dept. Approval . . , D-/A ................. Underwriters Approval .~...1.8.~.8.6..8 .............. Planning Board Approval .,. ,n./.a. ............... Request for Temporary Certificate ..................... Final Certificate ....~ ................... Fee Subm tted $...5...0.0. ...................... Construction on above described building and permit m~ets all appJ~-~/~es ~ regulations. FOI~M NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office 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 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 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 installations, 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. 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 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 ...... New Building ..... ~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .A~...~.I~...,~)..~..I.U..~..~.... ............ ..~....~.U..~.....~.'....~... ...................................................... Owner Or Owners Of Property ...~.a..~..~.....~...'..(~.~ .................................................................. Subdivision ............ ~ ................................................ Lot No......~. ..... Block No....~.. ....... House No...~ Permit No.....C-~....~....~..~.&Date Of Permit ...~...~....~...Applicant .~...:..~../~..J~..~.......~....~:......~..'......~....~.. Health Dept Approva ..J~.....~...~....~..~..~ ~. .... Labor Dept. Approval ..... .,~,...~... ............................... Underwriters Approval .~....J...~....'~.....~...~.~...'....~./.../..~..~./?'Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ...~. .................................. Fee Submitted $ Sworn to before me this ........... ..c... day of ......... Notary Public ..... ~-~~.. County · FOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPAI~TMENT Town Clerk's Office Southold, N. Y. TEMPORAR][ Certificate Of Occupancy No. Z..6~.~.1: ...... Date ............. DEC... ~.~ ....... , 19.~.. THIS CERTIFIES that the building located at .~.b.q .Dr.i?.e. ............... Street Map No..~'.x. ......... Block No.. ~ ...... Lot No..,.X~ .... ]~:Ar. gl...N. ,~.. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... AUg... 27 .... , 197~.. pursuant to which Building Permit No.. dated ........... A.~.S....2.7... -, 19.7.~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ?r.$v~.t.e..on~..£~.lF. d.~.e~ll~g. ....................................... The certificate is issued to ~.o.~. ~...g....g. 1..a~'~ ..... .t~n.. ~.r. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.oy...~...~.~...by..I~:..V.~].a ...... UNDERWRITERS CERTIFICATE No. N.i.8.2.8~.~ ..... .~.e~t....].~....~.9..~. .............. HOUSE NUMBER .............. Street .......................................... ur, til expirst!on of Bldg ' (good ............ B~i~ding SUFFOLK COUNTY DEPARTMENT OF HEALTH H . D . Reference No..33d--/3/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1.Applicant~Phone~&~/~ 5. Subdiv. Address~ 6. Section 2. Property 7. Lot No. 8. Private well ~ Village MA~'!~¥F,~ TownshipS9. Public water 3. Public Water Company name Distance to main 4. Lot size: Widt~_~feet Length_~___feet (Enter on center plot below) 10. Sewage Dispo~l ~ystem: _..~, A.//900/gallon septic tank: Precast ~"Equivalent__BL B.I L~,~ching pools: Number ~-~Precast~Block Spec ~ 1 o,,,~. in blanks w: --4 ~"~ Tank capa ci~_~M~Gals. Dept~ to G.w. 1~ Amount of water in well ~ ~ Test Hole Data ] Feet 0 I 14~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ~ ~ ~ )~ Signed '~' ~ ~_ ' ' ~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~' ~ ~ 2 Signed S-15 Revised 4/]/72 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO 4. 10. CONSTRUCT A PRIVATE 1. Applicant ~· W Address M~~ 2. Property location SEWAGE DISPOSAL SYSTEM Phone ~1~ 5. Subdiv. 6. Section ~ ! ~' 7. Lot No. 8. Private well Public Vil lag e~Township~9D~ s t ance water Public Water Company name to main Lot size: Widt_~j~__feet Length~feet (Enter on center plq~ below) Sewage Dispos/a~ S~stem: ~ ~:~ A. (~0~Zgallon septic tank: Precast ~'"Equivalent Bloc~__ -~ B. ~'~aching pools: Number ~-P-recast ~,~lock Spe'cial~ ~ If priv_~e w~ in blan~ be~: Tank capacit be in accordance with the Suffolk ards thereto." fill Total well depth Depth to G.W. ~085 &~ LS Amount of water in Test Hole The undersigned ~ERTIFIES: ' .......... ion of c''-~--~- installations will County Department of Health's current stand- Gals. Data ] Feet 0 Signed~ FOR HEALTH DEPARTMENT USE ONLY. Based on is the opinion of the Health Department, Disposal System ca~-~e installed on this Date /~/~ 7 Sil the information presented herewith, it that an adequate and satisfactory Sewage plot. S-15 Revised 4/1/72 , THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY ~-- ES JOHN STREET, NEW YORK, NEW YORK 1~OO$~ '~ .,,,e.'~epte~er z6. ]-.~7~, ~....,,o.~o.o.~..~z~. N 182868 THIS CE~IFIE$ THAT only t~e e~ ~ff~t ~,~c~ ~ a~nt~u~ ~yJ~ ~J~qnt ~ o~ t~ ~ fpplieatlo~ nu~r in t~ premises of unarles taPKorr, alpo D~lve~ orr weals I~., MaSt!~ek~ 4.1. in the following location; [] Basement [] ~t rt. [] ~nd r~. OUt ,~ ~ de ,Section Block rot ~--ex.mi~do. Septe~be~ 13, 1974 andfoundtobeincompliancewiththerequirementsofthisBoard. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST OUTLETS SWITCHES FLUORESCENT 19 38 20 19 DRYERS FURNACE MOTORS FUTURE FEEDERS DNITHEATERS MULTI.OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Water heater: l-~.Skw Motor/s: 1-1/2bp Elec. room heaters: 4-. 7~kw, 2-. 5kw S E R V I C E NO. OF CC. COND. A, W.G. NO. OF HI;LEG A.W.G. A.W. G PER .~' Of: CC. COND. OF HI-LEG OF NEUTRAL 3/0 iNO' ~F NEUTRALS 3/o ~2-2.5kw, 2-2.0kw, 1-1.Skw, 2-1.25kw, 1-1.0kw, Robert A Coodale, 525 Orchard St., New Suffolk, L.I. 11956 i1 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ' SUFFOLK COUNty H~H D~.pA~R~j~.~2 The Sewage disposal and wate~ Suppl~ facilities for this location have been inspected by~ni~s~ap_~v.l~ent~nd o Chief of ~eneral Englneerin~-~-n~-~-n~-~-n~-~-n~-~-n~-~-~.~.~_~ Services NOTE: II1= MONUMENT FOUND O= PIPE FOUND ~ ~/.OCHT/O.'q' OF WE/AS AND CESSPOOLg ', AHDIOI~ ~{0~ DA~A OB?A~N£D FROM \ MAY 11,197~ ALDEN w. YOUNG400 OSTRANDER AVENUE, RIVERH ~/NE SE~. 9~ 1974 SURVEY FOR: JOHN E. CLARK ~ PATRICIA A. CLARK LAU R E L JOHN E, ~ ~TRICIA A. C~RK ; GUARANTEED TITLE ~VISION TOWN OF AMERIC~ TITLE ~R~CE CO. SOUTHOLD RIVERHEAD SAVI~ BANK SUFFOLK CO., N.Y. BY~ SCALE: i "= 40' I DATE: MAY 2, 1973 ~ 73- 279 ,,o0~~ >, ~./ NOTE: ~= MONUMENT FOUND ~ ,, O: PIPE FOUND REVISIONS YOUNG & YOUNG ? ~ MAY 11~19?~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: JOHN E. CLARK 8~ PATRIClA ,~ AT LAUREL G,~ ',~ [~I ~ )c~ TOWN OF SOUTHOLD a . SUFFOLK CO., N.Y. BY~ SCALE: i.=40' DATE: MAY 2, 1973 73-279~ ' Disapproved a/c ................ ~ ..........~ ........... ~ ........ ~....~.. ~ . - _... .- ~ ~' % 1 ~ ~uuild~ I~rl. '~ ,. - ~7~ 7 ~ ~ ~ ~ . ~~ ~ APiCAl. ~ ~ ~lT ~: ~ ~m~ __ ~ o. This a~licati~ must be c~pletely fill~ in -~ · ~ ~ ~M~ In,tar, with 3 ~ of p~, ~cum~ pIM plan ~ ~le. F~ ~ ~ ~le. b. PI0t ~n~n~ l~atio~of, lot a~ of~iMih~.~ ~mMs, relatio~ ~ ~inJng pr~i~ ~ publk M~ m . areas, and gw~ qd~ail~ d~nph~ of ~ ofp~ust ~ drown on t~ d~mm ~i~ is ~ of ~is~licati~. ~ c~ ~e ~rE c~red ~ ~is a~tication may n~ ~ c~meK~ before J~e of Buildi~ Pe~it. ~ d. U~n oppr~al of this applic~i~, the Bui~i~ I~tor will issue a Buil~ Permit to the ~licant. ~h ~rmit-- shall ~ ~t ~ ~e premis~ ~ailable for in~i~ th~ t~ '~rk. ' e. No building ~all be ~cupJ~ or U~ in ~ole or in ~ for any pu~ ~atever until o Ce~ifkm of ~c~ ~all have ~en gmnt~ ~ ~e Buildi~ In,tar. B .A,P,.PLIC~ATION .IS HEREB. Y MADE to the Building Department for the issuance of a Building Permit pursuant to the u,aln.g.z, on.e Oramance at t. he Town.o.f. Southold, Suffolk County, New York, and other applicable I. aw~, Oldtnences or Regulah.o. ns, tar the construction of buddings, additions or alterations, or for removal or demolition, as herein de~cribed The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and re~laflam, and to admit authorized inspectors on premises and in buildings for necessary ir'-e~oectJons. f .... ""'~i~lCature of al~licar~, or ~na~me, if a Otal:)omtlon) · ........................................ ....................... ' (Address of applicant) / Iq ~ ~/ State whether apPlicant is owner, ILMee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. .................................... ................................................................................................... ,.., ................ Name of owner of premises ........ a.'.~.~. ...... .~...'. ...... ..~?.....~. ~.....~.....~ ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......................................... Electrician's License No:". ......................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ........ ..~.....~. ........ Street and Number ....................... ~..~.~t~..Q ........... ~.J~.L~..~.-.' .................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of propoeed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy .................... ~..J~..~.. ........... ~.~f~...~.~..~....~..~..~...~... ......................................... , "3.--J~'ature of work (check which applicable): New 'Building / Addition Alteration ~ ~' Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ............ ~...~....~.....~...?...~...5....~ ....... Fee .......................... .. ........... ..... ........ .. .......... ........~, .................... (to be prod on fihng th~s apphcatlon) 5. If dwelling, number of dwelling units ....~..~JL.[... .......... Number of dwelling units on each floor ...... ~.~..l'.~.. ....... If garage, number of cars ............~..-~.-O. ................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ ~ Depth ................................ Height ............................ Number of Stories ................................ J 8. Dimensions of entire new construction: Front ,l~.~. /..~.~.*. a,.,, ,,*' . .~....~..~~ ~. .................. Rear ....~...~. ....... .~.. ........ Depth ..~.. ..... Height ...../.r...:.;...--' Number of Stol-les ...... .4~...~...~~. .................................................................................................. 9. Size of lot: Fro~t ............ r~..~..~.. ..................... .~. ....... Rear ..../~..~. ........................... Depth/~.....~../..a..~.... 10. Date of Pu~hase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises~.are situated ...................................................................... .............................. 12. Does proposed construction violate an~ zoning law, ordinance or regulation: ............ ~1~..~. .................................. 13. Will lot be~regraded .. ~...~.~ .............. Will excess fill be removed from premises: ( ) Ye~, (~J~/'4o 14. ~.~lame. of Owner of prem,sesaeal~..~.PJlt~t£.~JLIle.....~...~1~. ,l~s .~....~.~..~...~..~...~....IL~.~xte No ....................... _- Name of Arch'itect .............................................................. Address~/..A.../T..L~.?..~..~, ........ Phone No ....................... Name Of Contractor .......................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Loca~e clearly ~ distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property I nes. Gv&"st~eet and block number or description ~ccording to deed, and show street names and indicate whether interior or comer'lot. STATE OF NEW ~RK~/ COUN~ Of .~~.., ' ~ - ................................ ~..~....~ .............. being duly sworn, d~ses and says t~t he is the applicant (Nam~ ~vidual signing contrac~ above name. He is the ...................... ~...; .......................................................................................................................... (C~nt~qctor, agar, corporate officer, etc.) of said owner or owners, a~ is duly authorized to ~rform or have performed the said work ~d to ~ke and file ~is a~lication; that all gt~tements contain~ in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the opplicati~ filed therewith. Sworn to be~ me this .......... ........ (~i~atur~'~plicant) No. ~2-S7 ~ -- ~ualified ~erm Expire~ ,I CH[OK BY: DRAWN i¥: LARWIN CO. ~g6g ~LO' 1 ENVIRONMENTAL DI R II:DTOR~ DESIGN STEWART NOTIFY BUILDING DEPARTM~ ~ ~.e-''t m~ ~ ~,l~ ~ ~fl ~ v~o ~r~i ,;~ . ~k. ~ ~J.~U 411 JOB TITLE SHEET o. wOO~A~ A.,.,. 71-()44 ~100 >,~il.hire4. boul~v,. ~d -A.D.D^.Z beverly hill~, oallfPrnla 02~ ~AVID L. SIMON 23 __of DAT~: CH[~K BY: D~AWN BY: ~ LANWIN C~. ( r 'r t E"NV OrNMENTAL ,DESIGN JOB TITLE ~s~'EwA.~' o. woo~^.o' ~.,.~. 71 ()/~/~ DAVID U'. SIMON. -. SHEET 28 __of¸ J 'r F I I CIR £CK BY: BCAL£,' DRAWN ~ LARWIN CQ. 1969 . ,-'~'~ = G;';.. ...... ~ .... . ~-~w.., ~. wo?o,,~,:,. -(144 A 910 O, W ~ I I h t r · b 0 u I e'v I r d hANDICAP[ ARCHITECT. beverly hills, celifornla 90212 DAVID L. SIMON ~ ~=, ~=. - --- 'T 4 .j t..~ ~=7 · k. r ? -T '1 ATE: C H ~'C I( DRAWN BY: LARWIN CO, 1969 ~x4 ~ ENVIRON D I IiI Ii: C TO RI: STEWART #e¥t)~t,y Thlll"l, ollifornla DAVID L telephone~ 878-3550 273-4, MENTAL C. WOODARD AI~CHIT£CT: p i~ O.I EC'r DESI*GN A.I.A. JO B TITLE ~ 71- ()4 4 JOB SHEET .25 __of-- ED. L... ED-V F I I DATE:: £CK llY: SCALE: DRAWN BY: (~) LA/~W IN 4F-- BLT ~L.-~_..VR?'I ~ ri J KENSINGTON., 9100 Wilahire boulevard beverly hit,la, california, 90212 ,teleph°ne 8T8-3550 ,27.3-4464 ENVIRON DIR£r~R: STEW'ART' I. AHDSCAPe= ~-AC H IT~CT: DAVID L., SIMON PROJECT MANAGER: MENTAL DESIGN JOB "J T t E .o. ~,OODAF~, A.,.'A. 71-()4 D £ S C,I~ I Ir , ¢; SHEET 26 __Of-- '4, DATer: · 'A~* '~1 CH£CK BY: BCAI.£: DRAWN 13Y: .~. © LARWlN ¢0. 1969 !1 S T:~ W:~ m ~ C' woo'o*"~ beverly hill., ealif'Ornla 90212 DAVI~ L. SIMON ~lephone 878'3550 273-4464 ~~~