HomeMy WebLinkAbout6795-zTOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupnncy
No..Z.~.,~0 ..... Date .......... Mai' ....i7 ........ , 19..77
THIS CERTIFIES that the building located at ..Rocky. P.~; .&. Aquav~ew. Av~;treet
Map No.. ~ ........ Block No... ~ ..... Lot No.xxxx .... Ea-~t .[4arion ............
conforms substantially to the Application for Building Permit heretofore fried in this office
dated ........... Au~ll~ ..... , 19. ~.~ pursuant to which Building Permit No... 6~.9~Z
dated .......... Au~..~.b, ....., 19..7-~, was issued, and confoms to all of the require-
ments of the applicable provisions of the law. The occupancy for which_ this certificate is
'~'"issued is Pr. ira.re..o~e..family., dw. elli~g..witl~ .fr or, t, .de~.k ................
The certificate is issued to ....M.~,..&..l~.i~'S..t~,cho, l:d. Clark ..... Ow~or..- .............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . Apr .8..~.97.~...by. R....Villa .......
UNDERWRITERS CERTIFICATE No. N327.930 .... ~;ar..~. 1927. ....................
HOUSE NUMBER ..... /iQ ...... Street .... Aq~.v.i¢~,; Awe ..... F~... ~arian ........
Building Inspector
IP~P--M' NO. :~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~ N.o 6795 Z
Permission is hereby gronted to:
..... ~ae~o~/; ....... Aq~X~ ....................................
to ...~,..~...~...~..v....~.e...~.~.~z..~v.,..~...~ ...................................................................................
................................ £,~ur.~4...l~Z..~..~.,.~ll } .......................................................................
Po d & A V~.ev Ave
ot premises located ~t ...~...~..~.~. ....... ~:~......~.. ........... ~ .................................................................
......................................... .$t.~.k....~.r.~'°'~.....~...X ,. ..............................................................................
pursuant to application dated .............................. Al~,.....1.1k ......... , 19.~7~.., and approved by the
Building 'Inspector.
Buildin
FOI~M NO. ~
TOWN OF SOUTHOLD
BUHIlING DEPARTMI~.NT
Town Clerk's Office
Sou~old, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at .,~.~..g! .~.17..~.~..~..~.~.Of.Y...~.?.7 S~t~
MapN B1 kN -- tN
o. ~ oc o. Lo o.
conforms subst~tially to the Application for Building Pe~it heretofore ffl~ ~ ~is office
dated ........... ~U ~%.. {~, 19 ~ p~su~t to w~ch B~ld~g Pe~it No.~.~ ~
dated ........... ~.~'...~ ~., 19~., was issued, ~d confo~s to ~ of ~e req~
ments of the applicable pro~sio~ of the law. The occup~cy for w~ch ~ ce~ifica~ ~
issued ~ .. ~... P.~ f.~ ~. ~ .... ~ 13. ~... ~.~ ~'~ ~ (... ~ ~ ~'.~ ~. '.~'. ~ ..................
~e certificate is issu~ ~ . .~!f~} ~.~'.~ .... ~ ~..~.~.~... ~...t}~.~ ~ ..................
~lessee or ten,t)
of ~e ~ores&d b~ding.
S~olk Co~ty Deponent of He~ Approv& ~?~.. ~,. ~ ~.~.~)..~[~...~.~5 ~ .~ ~.
~DERWRI~RS CERT~ICA~ No. '
HOUSE N~BER .......................................................
THE NEW YORK BOARD OF FIRE UNDERWRITERS
J ]' BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
o~y ~Ae e~trical equipment ~ ~cri~ ~low and i~ by t~ U~plt~t nam~ on the able a~licotion :~um~r i~ lac pre~s of
Richard Clark, Aquaview Rd.,' Off Rocky Pt. Rd., East Marion, L.I.
RX~ ~ { [ RX~RES ~ANGES -T~i~ OVENS {DISH WA~ ~UST FANS
Richard Clark ,
~r~, N,Y, 11~ ,
mutt not be oltered in ony menner; return to the office ef the Boor~ i~ incorrect. Inspecfors mey ~ identified by ~r cre~.
FOKM NO. $
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
$outhold, 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 end "pre-existing"
land uses:
I. 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 Bqilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property .~...~....~...~..L!..~....V:.!.~.L..~!......~...~.~..~. ............. ..~.~..D.....T~...~.....-~.~...~..T......-~.. )~A.~..~......~I...~.~
Owner Or Owners Of Property .....~..I..~..H...~...~...~.....C..~...~..~.I~.......~.........~....~. ...................................................
Subdivision .................... :. ........ ; ................................. Lot No...; ......... Block No. ~ ........... House No.....~....?....
Permit No.....~..?...~....~.....~Date Of Permit ..~.?..('.~..!.~..!.~..7'/~pplicant
Health Dept. Approval ..~..~...~,<l..~.~..y.~.¢.0..:./.~..~.Labor Dept. Approval ............ ..~...(.~. ...........................
Underwriters Approval .............................................. t'a nl g Board Approval ....................................
Request For Temporary Certificate ...... ...... ................ / .... ........ Fin(~l Certificate ..........................................
Fee Submitted $
Sworn to before me th~//
Notary Public.,,~... ........ ~. County
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ..... ~ ....... ~ ..........................................................
(stamp or seal)/~
FORM NO. 5
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ORDER TO REMEDY VIOLATION
Date
(addr~ Eo;~e rl~ EO~ aO~t~c~iztehder~g~x~tst~faO~ia)t ion of:
Zoning Ordinance ~-...~. ....................
Other Applicable Laws, Ordinances or Regulations ..........................................
at premises hereinafter described in the .~...~.~~..~.~..~.~...~.....~.....~/..~
/ (state character of violatio~
,~ o, ~.r~..:.r_~...~..:z~..~....~.=~.: .....
{State section or poro~reph o{ opplicoble I~w, ordinance or reoulotion)
YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the
conditions gb~ve mentioned forthwith in or before the ....~...~.....~,.."
day of. ................... ,
The p~mises to which this.ORDER TO REMEDY VIOLATION refers are situated at
Fcilure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute an offense punishable by fine or imprisonment or both.
,~r/ '~ ; · ~,, , Bufld~g Inspector
SUFFOLK COUNTY DEPARTHENT OF HEALTH
H.D. Reference No. ~,~C)--IO~.-
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM
1. Applicant ,~ ~f ~ q Phone~.~5. Subdiv.
Address ~0~' ~'~ .~t'c~ ,/~,e,~o~T , ~.~ · '6. Section
2. PKop~rty location ~4~ ~ ' ~O~ ~;mF 7. Lot No.
~0~ + ~o~ ~ ~ , 8. Private well
Village~f'~,~ Township~O~ 9. Public water
3. Public Water Company name Distance to main
4. Lot size: Wid~ feet Length feet (Enter on center plot below)
10. Sewage Disposal ~ystem: '
A. /90~ gallon septic tank: Precast~Equivalent Block
B. ~aching pools: Number ~ Precas~Block Special
Street
If private well fill
in blanks below:
Tank capacity~Gals.
Pump G.P.M. f
Total well depth
Depth to G.W.
Amount of water in
well
Test Hole
Data Feet
0
2
4
6
8
10
12
14
16
18
The undersigned ERTIFIES: "Construction of authorized
be in accordance with the Suffolk County Department of Health's current
ards thereto."
Date 7/i~ / ~'..~ Signed ~
installations will
stand-
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 ~) Signed~' ~
S-15
Revised 4/1/72
~./,.4' ~ _~ TOWN OF r~,u'mow ~ ~.~ ~ ~ . ~,
~ ~ -'~ TOWN ~'S ~FI~~ /~ ~ ~
.......... ........ ............... . / _
~pr~v~., ....................... , .............. , 19 ........ Pe~it No.~.~...~ ..................... ~"~ - -~
Di~ppr~ o/c ............................ ~ ........................... ~,T..~" ~ ~ ~ q~ ~ ~' ._
...................................
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
areas, and giving a detailed deSCriPtion of layout ofpraperty must be drawn on the dia~-bm which is part of ~his
c. The work covered by this application may not be commenced before issum~ce of Building Permit. ' ,~q
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sucl~rmit~'"~
shall be kept on the premises available for inspection throughout the work. ~
e. No building shall be occupi..ec!..or used in whole or in pa rt for any purpose whatever until a Certificate of
shall have been granted by the Building Inspector. I -
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pu_mucmt to ~be~
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Osdinan~ or
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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
O~ner
Name of owner of premises ..~.,...&..M3:;~.,...~;J,.~.~g~...C,],~J~ ................ :.~ ............................................................
If applicant Js a corporate, signature of duly authorized officer.
,/
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .... ...O~...~...e..~.. ................................
Electrician's License No...QS~J3~:: ..............................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Mop No.: ................... X, .................. Lot No ......... .1~ .............
Street and Number ..B...~g....k-~...~.~..~.n..~...~..~....~...&..~c~g.~..~.;~1~..Jkv.e~..J~.a~.~ ........................................
Municipality
2. State existing use and occupancy of premiseS and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ~ ...........................
b. Intended use and occupancy ............. ~tJ.~...g~.IL.~&UILJ.]~...I~I.~¢I~..1..~i~ ........................................................
· 3. Nature of work (check which 'applicable]: New Building .... ,r ........... Addition Alteration ~'
Repair .................. Removal .................. Demolition .................... Other Work ..................................................
(Description)
4. Estimated Cost .$2.2~.00~l .......................................... Fee ........... i~;~r~..~.~..~[i.i~.~..~.l~.i~..~.~.~.l.~{ ..................
5. If dwelling, number of dwelling units ...eno ................. Number of dwelling units on each floor ...........................
If garage, number 6f cars ............................ I:~zo ......................
6. If business, comr~ercial 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 ................................
8. Dimen~T~ns of entire new cc~nstruction: Front ........ .-~..~ ....................... Rear ..,~.~ ................... Depth ....:~.~.! ..............
Height .....~.~....e. ....... Number of Stories ...............o...p..~. ........................................................
9. Size of lot: Front ...... .]..~..0. .......................................... Rear ............ ,~,~0. ..................... Depth ....,1,5C)..~ ...................
10. Date of Purchase ............Jl~lk'..~,l~e...~,j1 .............. Name of Former Owner .,l~.]:~-[._..Shan~O.q ................
11. Zone or use district in which premises are situated ..... ~3~1 ............. .~ .......................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ................... .~...~. .............................
13. Will lot be regraded ........ ~o. .............. Will excess fill be removed from premises: ( ) Yes (x) No
.14. Name of Owner of premises .M~.....&.~l:a.....~....Cla.ck. .... Address -.~q,q~?~,~?...,J~J~one.-~o&'.-~'" ,....G, npt,. No..A2.7..~1992.
Name of Architect .............~;~'~lt..~ ....................... Address. No .......................
Name of Contractor ...~.~...~.~ .......... : ........... Address ...... ~ ........... I~hone No ....................... PLOT DIAGRAM
~ - Locate clearly and distinctly all buildings whether existing or proposed, and indicate all set-bock dimensio?s from
property I nes. Give street and block number or descriptio~ according to deed, and show street names and indicate
whether Interior or corner lot.
~"~TATE OF NEW YORK.
COUN'FY OF ....~.~...'~.Q~.~.,......)"~"~
............. ..~,.%..~..~.~'~.~.......~....~.~Z~.~,~X.~. ............................... being duly sworn, deposes and says that he is the applicam
(Name of individual signing contracf)
above named.
He is the .................. (::~..~.....~%.e,,,~. ........................................................................................................................................
(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
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
......... ............ day of ........ ............. ,,,,, ,,
Notory Public, ...~,~,,~. ........ ~...r~..~.~, County ................ ~....~ ....................................
(Signature of opplicant)
TERRI LEi: ELAK
NOTARY PUBLIC, State of New York
52-6168295
I~.0 /
Chief of' ge~e'r-::~L ~:,;[neerlng
CLAI~K