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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22622 Date SEPTEMBER 28, 1993
THIS CERTIFIES that the building ALTERATIONS
Location of Property 1155 AQUAVIEW AVENUE EAST MARION, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 21 Block 2 Lot 15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 26, 1993 ______pursuant to which
Building Permit No. 21248-Z dated MARCH 1, 1993
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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to RICHARD G. & NORMA M. MOELLER
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-28733 - AUGUST 24, 1993
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORM NO.
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°-N° 21248 Z Date ....1 19.E
i
Permission is hereby granted to*
~1..
01
at premises located at ....~`~7 ......^'..sir..d................................................
` AI
County Tax Map No. 1000 Section ......Pl......... Block ..........0....... Lot No.......
pursuant to application dated r IX 19L-~., and approved by the
` Building Inspector.
i oyy
Fee $ ..G~~........
i
Y:'JGr.. ..~C®.~°
Idi g I for
Rev. 6/30/80
i
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. 1 For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date 7 /
New Construction........... Old Or Pre-existing Building
Location of Property . I`~v~ ~'RST MPYZ1oP( „I .l
House No. Street Hamlet
Onwer or Owners of Property..?~i~H-P1219 G. 4 f`lorRMA,N, h'~o~Li K
County Tax Map No 1000, Section.. b~ Block 4,........Lot...4-5..................
Subdivision ....................................Filed Map............ Lot......................
Permit NoAtAa 4 .....Date Of Permit.. 3.1!#-~ .....Applicant.R/.q-N1qA HOELLEi-
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary? Certificate........... Final Certicate..x
Fee Submitted: ` CIO
CR~.• 1 h S~~O 2- APPLICANT • • .
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1,
10001 Z 1 BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date ItUC#OS9~ 24,9K93 Application No. on file MI(;2?19) 153 78 33
THIS CERTIFIES THAT
only the electrical equipment as described helots and introduced by the applicant named on the above application number in thepremises of
RICHARD MOEI1111M 1 1155 AQUAUTEW ROAD, EAST MARION, N.Y.
in thefollowinq location; 121 Basement 51 /st FL ? 2nd FL OUT Section Block Lot
teas examined on A N C U 6 T 16 , 1'19 8 and found to be in compliance with the 1Vatiohal Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
AMT. H P
OUTLETS INCANDESCENT FLUORESCENT OTHER AMi K W. AMT. K. W T. K.W AMT K. W.
6 6 6 C.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
K. W. OIL H. P GAS H. P. AMT. NO, A. W. G. AMT. AMP ANT, AMPS TRANS. AMT HP SYSTEMS
AMT. pMT. WATTS
NO. ST FEET
SERVICE DISCONNECT NO' OF S E R V 1 C E
AMT. AMP. TYPE METER i X ]W 1.0 RW 3.e 3W 3,e' dW NO. OF CC COND. A. W. G. NO. OF H4lEG A w o NO. OF NEUTRAL A. W. G.
EQUIP. PER A' OF CC COND OF HI LEG OF NEUTRAL
1 .10 C t. J 1, 4 C
OTHER APPARATUS:
c '
(r. 1T, b:~1t'9 1
SMOKE DETECTOR.-7
L'ANt, R, BURNS L1:C,0 282-ti
275 TOWN HARBOR LANE
S011TIEOLN I NY, 17 971 GRNERAt MANAGER
Pert
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton r~° SCOTT L. HARRIS Supervisor
Senior Building Inspector
Thomas Fisher V cra i` N Southold Town Hall
P.O. P.O. Box 1179, 53095 Main Road
Building Inspector
Gary Fish Southold, New York 11971
Building Inspector - u~ Fax (516) 765-1823
Telephone (516) 7654800
Vincent R. Wieczorelc
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JULY 26, 1993
RICHARD 6 NORMA MOELLER
1155 AQUAVIEW ROAD
EAST MARION, NY 11939
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
An application for Certificate of occupancy is
not on file. (Enclosed)
R%I[ No Underwriters Certificate on file.
The check is (outdated/not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT $ 21248-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
s1'_%D ~w..°.: .~J:i ~IUn:.. I~ ~C:4i•1 t.NT:
a
y
%OUtIDATI04 (1st)
ti
!OUNDATION (2nd) c"
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C e
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:OUCH FRAME & I o Cv,
.PLUMBING I vl
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n
H
INSULATION PER N. Y.
STATE ENERGY
CODE t
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s "3
FINAL
o
ADDITIONAL COMMENTS:
H
a
a
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H
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M-1802
BUILDING DEPT.
INSPECTION
[ J FOUNDATION 1ST ( ] ROUGH PLBG.
( ] FOUNDATION 2ND [ ] INSU ION
FRAMING ( NAL
[7
REMARKS-.. _cz2
DATE 7 6 INSPECTOR Aat3--14
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ NSULATION
[ ] FRAMING [ ] FINAL
REMARKS: DATE INSPECTOR A~4,4
M-1802
BUILDING DEFT.
INSPECTION
[ ) FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ] INSULATION
[ FRAMING [ 7 FINAL
REMARKS: _
DATE INSPECTOR
Consultant
,:sp N
3
Project Name
t 19W
SCTM #1000-
Date
The Southold Town TrustreSK_rlffi e has determined that your
application for alcoasta Er~c;an we.__andp -l is
<ncn-iuris_acY_iona]~/incomplete, please consider the following
information iri this regard for any required return submission:
r-
&~4 se Q Si PE dYf_
'.„l f~?2~/77!~CY <3ibrZ~S
CiA i17ti t4F' c, 4G%rpi~ for 4Au- Pie
ge 4
Tru ee Rep preesentative
e
cc: /Building Dept.
-zoning--Boar-d---of---Appea-ks
PIanning Board-
-Canee-rvvat~"dv seamy--CounG3
This notice makes no claim with respect to other jurisdictions
within or outside the Town of Southold with respect to permits,
permission required.
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BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
y p
i ~ . ' ` TOWN OF SOUTHOLD --SURVEY _ _ .
BUILDING DEPARTMENT ^ CIIECK _ _ _ ,
FEB - 8 1993) TOWN HALL SEPTIC FORM
L SOUTHOLD, N.Y. 11971
TEL.: 765-1802 r:oCALL .
CALL
ExaminedL?,~ 19. _ MAIL TO:
Approved , 19 Permit No. ~ _ .
Disapproved, a/c ...................................A • ~
.......77
/ (Builor)
APPLICATION FOR BUILDING PERMIT
Date -ft., 19M
INSTRUCTIONS
a. This application must be completely filled in by typewriter 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 giving 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, 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 building for necessary inspections.
(,C t%, Gtr . N~~~ g ti, .
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OWi`.C
...................................~.,II............................................................
Name of owner of premises .~(C ~nt~rcL. !SOY YV\C ~Qel•~~t , , , , , , , , , , , , , , , , , , ,
(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....%~
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done. 2 .
...I(SS.... `.!~C1V...... ~f...r..° .................M0.v-1....) X......................
House Number Street Hamlet
County Tax Map No. 1000 Section y- j........... Block ".;r Lot ...k5............. .
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy LLWI Yvi eP , , c~ v\~ W,ee e v H o VV.N.
b. Intended use and occupancy
• ~i
3. Nature of work (check which applicable): New Building , Addition C Alteration .
Repair Removal Demolition Other Work
e (Description)
4. Estimated Cost Fes'"...............................
(to be paid on filing this application)
'
5. If dwelling, numnumberber r of cars dwelling! ; units I , Number of dwelling units on each floor
If
garage,
...of use ............y .
7. D basiness, business,
lions of commercial merctins structures, i • • y, spec nature a . ` . . . .
Height o . Number occupancy, specify nd extent of each type
I businl or mixif any: Front ....u~~!V . .a....... Rear v'ZP....... Depth
of Stories .
ith alterations or additions: Front /r'J............ Rear o
Depth siA/F f same structure w . . . . . . . . Height' 3 Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories ..................................:.ti........'.......... .
9. Size of lot: Front ...69 Rear v1 Depth .
10. Date of Purchase 11194. (9`~v~- . . . . . Name of Former Owner S&e:jja.3 , .
11. Zone or use district in which premises are situated ....re,5,tN~u-t, . . y~
12. Does proposed construction violate any zoning law, ordinance or regulation: 7 p .
14 ll be removed from premises: Yes No
13. . Name of Owner o regraded v ' ' • Will excess fi
premises liGt1At,. Address S9 .2ACLj Pa., , , Phone No 4 G4.
Name of Architect `fit' 5-,36 8 ,
1 f Address V"t~,j * e` " n1 Y., 'Phone No............ . Name of Contractor . . . . . - , Address .......~..y . Phone No............... .
S~,
15. Is this property within 000 feet of a tidal wetland? *yes....,... No.........
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all'i buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block !number or description according to deed, and show street names and indicate whether
interior or corner lot.v_m4lgt,) ~Je
at
propo5er~.w~~'etwj"toV1
a aR
See serve ,
~ work lhd.t z~- iv< red.
- oNJP1 Shy wA be tew vile
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it
STATE OF NEW YORK, S .S
COUNTY OF
o t mo n M oFJL (e.r.. being duly sworn, deposes and says that he is the appheant
. (Name of individual si ning 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 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 l 0 - 19 .9 3
r / phi -
Notary Public, County
,c
Notary JOYCE S."LKINS ~
ate of New York (Signature of applicant)
No. 4952246, Spffolk Cou
Term Expires June 12, 18
12 T4r4 93
AIMENDV0 i v T/,N
NNDER`1'RREQUIREDtIFICATE
I
CIF:.. ~-A P YED AS NOTED
DATE: DATE: ~,l B.P. b VAT
FEE;FEB 81993 _ FEE: . NOTIFY 6 ILDI G DEPAR 765-1802 9 AM TO 4 PM OR THE
NOTIF 765-1
FOLD FOLLOWING INSPECTIONS:
1 FO 1 FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
~v.•~.,314d' 6 A-re~ ~+l'66 _ 2 RO 3, INf 2. ROUGH - FRAMING P PLUMBING S. INSULATION
4, FINAL - CONSTRUCTION MUST
mA!'~ IS UE` L no%" UL - I 4. FIB BE BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
S,,rvPJT OUT CERTi Ia,sATE ALL THE THE REQUIREMENTS OF THE N.Y.
^ STATI ~Ivj•'4 ~@, r~"tis~~'C ^Y CODE STATE CONSTRUCTION 6 ENERGY CODES. NOT RESPONSIBLE FOR
DESII DESIGN OR CONSTRUCTION ERRORS
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