Loading...
HomeMy WebLinkAbout8716-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..~?.~.0. ..... Date .............. ~al~...~0 ...... , 19:~.~.. THIS CERTIFIES that the building located at ...8../.~..Bk..uRk....I,.a.n.e. ........ Street Map No. ~ ......... Block No .... ~ .... Lot No, ....X~. ..... . .C~.t..~gu..$...1~. :¥., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .~.":~ly...5, 197~.. pursuant to which Building Permit No.. dated ........... .JB.~.y.....8..., 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 issued is . p~.l~t~..~.e.. 9~.~.. f~.~.~,3,y..d~l..l~,r~ ...................................... The certificate is issued to ....G.e.?~?.d...&...B~..~.b?.~..~ :..~.o.~..oF ........ .0~1...e.r?. ........ owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J~ . .].~'...]9~.~.....by...R,,..V.$.~,.a.... UNDERWRITERS CERTIFICATE No. ]~.ll~.l ~6 ..... N~y.. 2~ .. ~ ~.?.6 ............... HOUSE NUMBER ..... .~'~).... Street .... .~.k.~¥k.'..~[.a~.a. .......................... Building Inspector 1~0~,~ NO. ~ 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) 8716 Z Date ........................ ~ .'; ~' ....... ~ ............ , 19.~'~... Permission is hereby granted to: .................... ~-~e ...................................... to ..~...'.~..;~.~ ..i~ ~... ~;u~.. ,,;~L~.]c.. ,', ~,,~.£ ~i~ ..................................................................................... at premises located at .~./.~.....i~.~'~g,~,';...+,~,l~......~.~:..A.?.e.) .............................................................. ................................................... .......................................................................... pursuant to application dated .........................~"~'.....1~. .............. , 19.?:6..., and approved by the Building Inspector. TOWN OF $OUTNOLD , 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 $1.00 New Bqilding ..~ Addition ................ Old or Pre-existing Bu'ldmg ................ Vacant Land .............. Subdivision ................................................................ lot No ............. Block No ............. House No ............. Dept. Approval .£/~...~../..,~..:.~. ................. Labor Dept. Approval ................................................ Health Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fino. I Certificate ..~ ......................... Fee Submitted .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before met his ~/~'~/~ ,THE NEW 'YORK BOARD OF FIRE UNDERWRITERS, 8.5 ,JOHN STREET, NEW YORK, NEW YORK 10038 : THIS , aeral .M. Conroy,..Ba~l~ve., s/side of ~oad, ~Broadwaters Dr. & Nassau ~ Point Rd~'~Cutchog~;.L.I~' ' . ~'~ ~ ~ ;~ ~-: ~,~ ~', ' ', ' ' ' FIXTURES , RANG~ -OV~S G.F,I,........ 1 Smoke Dete~tq~ ':.' Gu st aY' Bartra, 22?' Eas$:~B~'eak~ater Rd., Mattltu~k, L.I. 11952 This certificc~te must ~ot be atfered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. /, © formerly '~ ' erlY,~o "'" ~ ~ 0/ ~h~l· ~E~VlC~ = ~IV~TE SURVEY FOR: ~EW ¥ HOWA TOWN OF $OUTHOLD TOWN CLERK'S OFF~CE ........................................... Z. .................... ....... .... ............................................... ' (Bdilding Inspector) APPLICATION FOR BUILDING PERMIT Date .................... ~1~....~., ............. 19...Z.6 ..... INSTRUCTIONS a. This application must be completely filled in by typewriter o~, 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 os areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue 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 ssuance 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, buildin~g 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 name, if a corporation) 250 Cox La~e ....... ~hg~,...~..~Qrk....l~ ............................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder ................................................. Name of owner of premises ..... ?.`.e.r.~..r.9~.~.~.~:.....~..~.9.`~.~...~.Tb..~.?..~.~.~.g..:....g.~..~...~`.~...~. .................................................................... If applicant is a corporate, signature of duly authorized officer. George Ahlers, (Name and title of corporate officer) Builder's License No ..................................................... lumoer s ~.lcense ~1o .... z~/d'O ~- I/ ................................. Electrician's License No...~./..?..G.~..~.~..~'--'~''''' ........ President 1. Location of land on which proposed work will be done. Map No.: .... ............................. Lot No .................. Street and Number ........................ ~.~T~...&Y.~t~.,.[-~ku~lc..T'~e-)..-C.u.C. c3q-~ue.,...~e.~..~o~ .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ dwelling b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building' ...X. ............ Addition .................. Alteration ................ Repair .................. Removal ..................Demolitior. .................... Other Work ................................................ .... 4. Estimated Cost ..... ..~.~.8..?.~..8..0..:..0..0.. .............................. Fee /~7/~" ~ - (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 ......................... .~ ............................................................................................................... 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 ................................ ~.~., 21' 21' 14' Dimensions of entire new construction: Front* ...... .............................. Rear ............................ Depth ........................ Height .................... Number of Stories ......................... ..~. ......................................................................................... 9. Size of lot: Front ............. ~Q2,,.3~,.~. .......................... Rear ....... ~,,,.~ ....................... Depth ....]..~?.:.6~)~ ............ 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 k ) No 14. Name of r~ ~ .... ~: Gerard M. & Barbara Co~4~92~~ 3034 Avenue T~^.~ k,^ ......... ~ ....................................................................... B:~6.6~i~;... N~-~6,:~ ~ ........................ Name of Architect .............................................................. Address ................................ Phon~ No ....................... Name of Contractor ...Q...e..°.~.g.e._..A...h..]:.e...~..s..L.~.u..i...]:.d...e.?. ..... Address 250 0ox T.ane Phone Ixl~ 73/4-50]-0 ~'~6~'~';'"~ Y6r~' ........................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, (~nd 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. STATE OF NEW YORK, [ S S COUNTY OF ............Suffolk. J · ..................................... .~:,~]LJ~i$,I~*.J~! ...................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contrac0 above named. He is the .......................................................... ~J~.~.,.:~.~,..~..~l~...~,....~....'.'~...?. ...................................................................... (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 ali 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 .............. ~'J;h.. day of ............................. .~..~'....., 19...~.6. Notary Public,. ................................ ~1,~.~.~..~..~... County ................... ~.~..~... ....... ~ .......................... ~ J ~% ,~, % ., (Si~,rJo.ture of applicant) , ~[L~/~ETH ANN NEVILLE NOI~RR¥ ¢U'~!¢, State o New York Nd. 52-Fi.~JO, Sufto k Term ECx~p~e.~' March 30, t)j PARTHF. N [ OF HEALTH APPLICANT~ ADDRESS TEL II~K COUNTY DEPARTMENT OF HEALTH Sr:lJq/ICJ~ FOR APPROVAL OF CONSTRUCTION ONLY ,,?/~, z~'. . .s ,F. NO. f~ - ,SO ~ ~ ~0, ~IOTE: ~ = MONUAIENT' 0 = PIPE WATER SERVIQE -- Pf?IV~ATE WELL NEAREST PUBLIC WATER {vIAIN = 5 M/LES REVISIONS " ~ ,lNG 400 'eST RA ~..~R HEAD, ALDEN W YO~JNG SURVEY FOR: GERARD M. COIVROY NEW YORK HOWARD W, YOUNG LAND ~URVEyO~ BARBARA C. COIVROY AT GUARANTEED TO' EAST CUTCHOGUE TOWI~ OF SOUTHOL O SUFFOLK CO., N,Y. I -- ~0 dUNE IB~ 1~7~ [OqA~I~ON OF WELLS AN~ CESSPOOLS SHOWN HEREON AR~ FROM F!ELO ~VATION$ A~ OR FRO~ O ~IOT£ ; ! / t Ir "Alteration of this Documet4 ~xcept by a Lit. cad Proim- $~,nd Engineer, ~,, Illegal*'. Section 7209, Subdl~/~ 3, N. ¥. Slate Ed~aad~e Law. ,,I Office Of , Gordo~a K. Ahl~lrm, P. E.