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Home My WebLink About8935-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi icnte Occupnncy No. Z8909 ...... Date . J.a~uax:y.....1.3 ............ , 19..7.8. THIS CERTIFIES that the building located at . 2~0~..W.e..l~.s..A..v.e .......... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . June...lb: .......... , 19.77. pursuant to which Building Permit No..9.3.(~.. 'J~ . dated .. June...1.be ........... , 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 ... Rriva.te. One .Family. Dwelling .w/additl(~n ....................... The certificate is issued to ~ .Geo. rge. &.Mar. gare.t .McFadd,~n ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ N/R ........................ UNDERWRITERS CERTIFICATE No ................. ~I/~ ........................ HOUSE NUMBER . .2~0~ ....... Street ............................. ......................................... s.o.U.t~o.~..~.,' .~e..~. ~o..r.~ .... .~ ]?.7. ~. ........ Building Inspector ,TOWN OF $OUTHO/D E~UILDING 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? 8935 Z Permission is hereby granted to: ~dJ~ ILS /~, V ~ at premises located at ..................................................................................... ~ ...................................... Building Inspector. Fee $ ........................ Building Inspector FOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, No Y. Certificate Of Occupancy No. ~. ?.~.2.2 ...... Date ........... .A~ .l'i~ .... 2.6 ..... , 19.7.~.. THIS CERTIFIES that the building located at . .k/el;La. Av.e. ............... Street Map No. X~OCX ....... Block No... x~ ..... Lot No, .x× .... Sout, hol~l. · .~,~/., .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ O~t.. ~J.., 19.7fi~ pursuant to which Building Permit No..~°~3.~.~. dated ............. .(let...2~., 19..7.6, 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 P.r. iva.~e .o~ .~,am£1y.d~.m~.2~ng ....................................... The certificate is issued to (leo~.~a. M~Fadd~r~... rl~ne~,. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Apt. il...8 .. ~ 9~7... by. .R,..V. ill~ .. UNDERWRITERS CERTIFICATE No. N~32.~.28.. Apr, .~.l .. ~ 9.7.~. ................... HOUSE NUMBER .... 2.%0~ ..... Street . .%i.e. lls. AVe .....$o.~hol~ ............... FOH, M NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 3. Copy of certificate of occupancy $1.00 $5.00 D,,te ... ~..e..c..~m...b..e...r......2.5.,....1.9 2.5.. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........ ~.~..0.~..~]..e..];.,~.,.4.Y..e. ........................................................................................... Owner Or Owners Of Property ...... G,e. om..6~...&...~,z'.ga2.e.~..}~c.~c~el~ ................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~.~.,0.~..~. ...... Date Of Permit ,,.~,/..J..bf/.~..'~..Applicant .... ~.~,~.~ft~.fh~...~LC~.~.~].~ .................... Health Dept. Approval ........ ~'../.~. ............................ Labor Dept. Approval ~/~ Underwriters Approval .......... ~./.~ ............................ Planning Board Approval .~./...~. ................................. Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ .,,~..*..0..0. ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .......... ~a ~'.~z':. e.~.. Z~a F.~,CiA e ~ ..................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ,/, TOWN OF SOUTHOLD , Building Depmtment 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: i. 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 ......X. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... .~...e..~...]_.~...A..v...e..~.?t...e..~.....~...o..~.~.,~.,o..~..~.....~..e..~....~.~. ............................................ Owner Or Owners Of Property ........... G...e..o..~g..e.....~.~.e.,~ ....................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No, ,..,~.?...~.~ ........ Dote Of Permit ,]:,0.,,/,~..~./.~.~..Applioant ~.e~.~.~.`e.~.A.~`]:.e.~`~`~`~.~...~..j;~.]:.~.e..~.~.~.~`~`~`~ Health Dept. Approval ..~/..8. Z/.~7. ............................ Labor Dept. Approval ......... : ...................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate .......................................... Fee Submitted $ · Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... George Ahlers, Sworn to before me this ...... of Notary Public ......... Builder, Inc. (stamp or se~l)~, TOWN OF $OUTHOLD TOWN CL WS OmC SOUTHOLD, N. Y. Examined ........................................, 19..2 ..... Appdcmi? ~o ................................ ,~ ~roved ~L"~I ~ 19~.. Perm t No .,~.ZZ.~ .............. ............................................................................... ............. ..................... ...................... (Building Inspector) Dote ..............~,~..~.~ ~ ......... 19.~.....~ INSTRUCTIONS ~ o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing ocation of Iot 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 port of this opp icotion~ 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 issue a Building Permit to the applicant. Such permirt~ 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 o Certificate of Occupancy shall have been grunted by the Building Inspector. ~ APPLICAT ON S HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffo k County, New York, and other applicable Lows, Ordinances. o~¥, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ta.J admit authorized inspectors on premises and in buildings for necessary inspections. 0~ (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. Builder . Nome of owner of premises ........ .Ga.arga..~c~.a.dd.e~ ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. ........................................................................................ George A~lers, Pres±dent (Name and title of corporate officer) Builder% License No ....... -~..~. ......................................... Plumber's License No. ...4.~3...~. .................................... Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which propose~9/~, will be done. Map No.: ........................................ Lot N6 ......................... Street and Number ...... ~.e.].3~..zcg.~.~.,...~.o~1.t2t~oZLd .............................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................ Intended use and occuponcy ..... .qt.~.~.~l,~.~l, Og2 ....................................................................................................... ~,' 3. Nature of work (check which applicoNe): New Building' ....~. ............. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost ...~3.]..,.~..9.~.^Q.Q ................................. Fee ............................................................................. . ............. (to be paid on filing this application) 5. If dwelling, number of dwelling units .]. ......................... Number of dwelling units on each floor ............................ If garage, number of cars ~D~e . 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 ................................ ?r 8. Dimensions of entire new construction: Front ...... ~. ............................ Rear ......~.~.~. ................. Depth ..2..~..~. ................ ' Height .................... Number of Stories ................................................................................................................ ;I .... 9. Size of lot: Front ..................... 'L0..~ ............................ Rear ....... 'I2.Q ........................... Depth ..~.~.~ ....................... 10. 'Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (:~) No Name of Architect .............................................................. Address ................................ Phone No ....................... Locate clearly and distinctly all 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. SI'ATE OF NEW YORK, ~ ¢ c , COUNTY OF ...Suf£o],~. ............ ~'~"~ ' · ' ....................................... ['=al::~..~!lz:t~r~P.o. .................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the .......................................................... ag~,,l'~.~...f.or...co~tr&c.~o~'. ..................................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 28.th ..... dayof ........... C~.to];~. ................ , 19..'/.~... Notary Public, . ................................... S.g,f~o.],~,County ': ................................................................................................. ~ ~r.~/~ ~/,~~ ~~ (Signature of applicant) ELIZABETH ANN NEVILLE NOTARY PUBLIC, S!?~e of N',w Yilrk , [ ~% P L J ' 6" ' i Offiae O! Cgor~on K. Ah. ler.~, P. E. "Alteration of thll Docume~' except bT c~ Licensed Profes- siond Engineer, IS Illegal". Sechan 77.09, Subdl~'~¢:~ N. Y. State E~lucatlon L~w. ~ilteer Approval yaldZ ~ and Section 7209, Subdlvl$1oll