HomeMy WebLinkAbout8646-zNO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No...'~...V..~...~. ? Date ................. /~.f...~../~..,
THIS CERTIFIES that the building located at ] ~/. 5~.5....~c.~.¥~,~..~:'~.~..~/t [ Street
Map No... ~ ..... Block No......-//~.....Lot No ..... ~ .......................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... ,J~f¥~ ....~{., 197.(~. pursuant to which Building Permit No.~(~.L{/~
dated ........... ~(~![...~., 19.~.(~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to .[~.~ ~...~. ? .~.~.....~. .... O.~'.~..~J. ~J. ~.. (~ ~ ./~ ............
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval~4~.~/ ~ ~7(~..~[ ~ .../~.~ J~0.-. [{I .....
UNDERWRITERS CERTIFICATE No..N..~1 .I. 7.2.7. ...............................
HOUSE NUMBER ~.~ .5. ~.~. ....... Street . ~O~..~( '~....~/.( ~f.~/....~.~.~. [ ...............
Building Inspector
FOEM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N: Y.
BUILDING PER/~41T
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 8646 Z
Permission is hereby granted to:
..C~z..o.. ~.~.~ .....~;1~.~....~.,A/.C...Ra.yae~ad
.............. ~.~.~ ............ , .......... ' .......................
~o .....~..~..J::],.d....~..e..~....o.~.e...~.:~.~y..ff.~..C.~;~g .................................................................................
at premises located at .~..~..~D. tl~...~.t~..A~ ................................................................................
........................................................ · ~a~;hot~l.... N,'~:~ ......................................................................
pursuant to application dated .......................... ~,.'Ql~.e.....1..~. .......... , 19..~., and approved by the
Building inspector.
~ORM NO. 6
TOWN OF $OUTHOLD
~ Building Deportment
Town Clerks Office
$outkold, 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 approva~ of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Nomconforming 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
Date ...~..o.~.e..m.,b.,e.~...Z...8.,~....Z.~q.~..~.. .....
New B~ilding ...~. .......... Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ...... ,,~.,o.~..~..~..,.~.~...e..~.....A.~,e.~.~..e,.~.....~..o..~...~.~..o.~,~ .............................................................
Owner Or Owners Of Property ~f~yJ3]g~..C.,...g.~.~'.fl~fl~,~. ..................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No. 8~/~6Z Dat~_tqfp~rrn,f./..]-..~.L~.~.......Applicant~/~.~.~ George A~].ers, Builder, Tt~o.
Health Dept. Approval ..... ~.-..~.O.~.].]]. .................... Labor Dept. Approval .................. ...~....~ ...................
Underwriters Approval ...~.~,..];.~..~..~,.~,.]_~L/].]_/76 .......................... , Planning Board Approval .............. ~"*""~ ..........
Request For Temporary Certificate ........................................ Final Certificate ..........................................
$
Fee Submitted .................................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ~.~...... ,'.~...~:~.~.~~ ............................
GEORGE AHLERS, BUILDER, INC.
Sworn to before me this
................ day of ............................................
Notary Public .................................... County
(stamp or seal)
Raymond Offenhelser~Soundvlew~ North Side~ Southold~ Loi~ :.,~ ,:}: '~'
~ 1001 OB
APPARATUS:
Mot or~: ~- 3/4hp o
1-$~oke Detecto~
BUILDING DEPARTMENT
TOWN CLERK's
~UTHOLD, N.
~provea ..~ ............ ; ...................... , lY./..~., permit mo. ~..~ .............
. .......................................
.........................................................................
..................
(Duilding Ins~tor)
APPLICATION FOR BUILDING PERMIT 4~
Date ................... ~T.u~.~...~../q, .......... , 19..?.~. ...... ~
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 oF
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.
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 o Building P~rmit 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 ir~ buildings for necessary inspections.
GEORGE AHLERS, BUILDER, INC.
(Signature of applicant, or nome, if a corporation)
.... .. _E,.X., ........................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu/Ider.",~
Name of owner of premises ......~..~.~.o...~..~.....C..:...O...~..~...e.~.e..i...~..e..~.. ..........................................................................................
If applicant is a corporate, signature of duty authorized officer.
George Abler ,
(Name and title of corporate officer)
Builder's License No .......... .~.~ ......................................
Plumber's License No ......... ~ ................
President
Other Trade's License No ...............................................
Location of land on which proposed work will be done. Map No.: ............ R9.qf)..-,2 .............. Lot No .........................
Street and Number .,Sound View A.¥en.¥.e . ~ .. .
Municipality
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 ............. ~W..e..]:.]....i.~.~. ...............................................................................................
3. N~]tur~ of work (check which applicable): New Building' .....g. .......... Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior. .................... Other Work ................................................ .
(Description)
(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 ............................ 2....q.a...r. .....................................................................................................
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 sarne structure with alterations or additions: Front .................................... Rear ............................
Depth ................................Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front .......... .Q ....................... Rear ...... .~.0. ................. Depth ...... .2..8..! ............
Height .................... Number of Stories _..'1~ ............................................................................................................
9. Size of lot: Front ......................... ~).'l..~. ................... Rear ............(:Jl,~ .................. Depth ...... 2.~0. ..................
10. Date of Purchase ........................................................Name of Former Owner ........................................................
~ L Zone or use district in which premises ore situated ................................ .A.. ..................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded . ........................... Will excess fill be removed f~r(~o.l~remis~: ( ) Yes ~ ( ~ No
J-U.~U ~:. ~ancas~er Avenue
Name of Architect ..............................................................Address ................................Phone No ....... ................
Name of Contractor George Ahlers -.. 250 Cox Lane
PLOT DIAGRAM
Locc:te clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore
property lines. Give street and block number or description according to deed, and show street names end indicate
whether interior or corner ~ot.
STATE OF NEW YORK,
COUNTY OF ............ S~££oZ.k... ~~''
................................. .~.~'a&o.~,..[~.~..t~'~c~3 ........................... being duly sworn, deposes and says that he is the applicam
(Name of individual signing controct~)
above named.
He is the ..................................................... ~,F~D.'~..~.Q~'....~.Q~'.~,~.~T. ..........................................................i ................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to m(~ke and file
this application; that all statements contained in this application are true to the best of his knowledge and belief; ond
that the work will be performed in the monner set forth in the application filed therewith.
Sworn to before me this
......... .'[,5.~h ..... day of .... .~.g~ri.f~ ,19 ~.6.. ~~ ~ .
. ............. ..... ..............
fl NEVlLI~
NOTARY PUBLIC, State of New York
No. 52-8125850, Suffolk
I
; f.,.~.,,.l/i =
17'
lUFF CO ~ ~ HIALTH IIMYK~I
H. ~- NIF. NO.:
AF~ROVF.33:
ITAN~M~DI OF IAJF~OLK ~(~ DI~T.
OF HIAi.'II~. IillV13
(e) A~CA~T '
O~,*~NER: e~UFF. CO. HEALTH DEPT. APPROVAl. I H. $. hK).
,r..-~. C ,'/. '.< C' ' ," r', ,'--" :~ ,~. ,' ".. ~_," , ~.," Name GEORGE AHLERs
~,,,, .. ~' ~, ~ : ~ Coml~ny Poslf~on Presiden!
----- ' 250GEORGE AHLERS BUILDER/NC.
.... .~ ,. '7 / "'" ' Address
COX
LANE
" ' ~,UTCHOGuE, N. Y. 11935
DEED: .... ~. ~ ~'. //~
~ ~ ~o ~ ~ ....
/zz,'r ro ~orPo. ' ~ o.° i ~/.~ ¢'L" ' ~
~o eJ A V~UD rr, uE cc.v,
__j ~ GUARANT~ES INDICATED H[REON SHALL
i ,
.T
NOTIFY ~1~ DEPAKTMENT AT
765-2660 ~
L ~-,Ns~CT!~:
beFORE BACKFILLING ~NDA-
t I ~ N ~R START FRAMING
z. B~OR~ COVERI~ PIP~LINE
s. PINAL ~H~N I~ C~FLETED
~OT ~ES~S~ ~R ~SIGN OR CON-
I
,.~ 1 p P_-.. · C;:: L r--- VAT) oN.