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Home My WebLink About9551-zFOI~,M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...zg0fl8 .... Date ...May ..... .~0 .............. , 19..7.8 THIS CERTIFIES that the building located at . 2'10.. Sttu~ntt .Road ....... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. November...'15 ..... , 19.78. pursuant to which Building Permit No..955.~Z. dated .. Noveraher...1.5 ...... , 1978.., 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 ...... PR.T..V. ATE. ONE. FAlVEELY..]D'~rELL~I~IQ .................................. The certificate is issued to ..... A~be~.~ .Wu~h .................................... (owner,~ of the aforesaid building. Suffolk County Department of Health Approval ....... ~./2./.78 .... 7.'..S0.'.~.67 ......... U DERWRITERS CERTifiCATE ..... ...................... HOUSE NUMBER 210 Street Sur~mi~, Road SOu'~ho3.d, New York Building Inspector (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)' 9551 Z Permission is hereby granted to: · . g.~.~ .h..o. ~me. .................................. at premises located at .~.~.....~13J~:L~,..]~.~2i~'e ........ .(.~.°..~'.~..°.A...~..~..~.)......: ....................................... pursuant to application dated .......................~.¥ .......... .~ .......... , 1~/.~/.c.., and approved by the Building Inspector. F~ ,...82.~. ......... FORM NO. 6 TOWN OF SOtJTHOLD Building Delm~tmont Town Clerks Office $outhold, N. ¥. ]]97] 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 aT property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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 o 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 Date ...~..~. ~.....~..0..*....1..?.Z..~. ................. New Building ..........~ ....... Old or Pre-existing Building ............................ Vacant Land. ........................... Location Of Property ...... ............ Owner Or Owners Of Property ..j~.~).~.~.~...~.l),~.~g ............................................ i ........................................... Bawiew - - 22 Subdivision ........ v ....................................................... LO~ No ............. Block No ............. House No ............. Permit No. ~5.~..1.. ....... Date Of Permit ....~..~./..]¢.~../.~Applicant Geor[e A.~..~. rs~ ~.uilder, Znc. Health Dept. Approval 5./2./7.8=.7...S.g..Z..6..Z.. ............ Labor Dept. Approval ................................................ Underwriters Approval ..~../.~../.7...8..~..~..8...~../'f.~.9 .......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ ..... ~..~ ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ...,G.,,e. grge~Ahlers..'.....Builder~ I.~.,c,.: ................................... Sworn to before me this i~i~~,~ ................ day of ............................................ (stamp or seal) Notary Public .................................... County &'~-/L~- '7 ~ fl THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY j-'-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~-, J~ty 1, 1,978 ~fpp,..,o,. No. o,./,,. 9~968 N 3 THIS CERTIFIES THAT m~Jy the e~ctrleM equlpme~t ~ ~ ~ ~ int~ ~ t~ ~t ~ ~ t~ a~ ~p~a~ n~m~r AZUre ~rch, Smtc Rd. ~C~, L.X. ~ erami~ on ~r ~ ~ 2 7 f ~978 a~found to ~ in compli~ce ~ith ~he r~ulrements of this ~. 31 36 31 DRYERS EJRNACE MOTORS PU'flJRE APf, UAI~-~ ~E~ TIME CLOCKS UNIT HEATERS DI~&M~RS SERVICE ENSCQNNECI' S E R OTHEI~ APPARATUS~ I Imokm detmeCOr Hot ~mter Slme,t~urnieet l-X8.&im, 2/0 C 1 2/0 217 E. lrealmaCerild, tlcctcuet, L.Z. 11952 .11. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified COPY FOR BUlLDINO DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MIR. TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N.Y. ~-- ............................... ..... .......................................................................... ...................... AP~C~TI~ FOR BUIL~I~ PER~ ........................... o. T~is opplicotion must be completely fill~ in by ~pewriter o~ in ink ond submitted in triplicote to the Building~ Inspector, with 3 se~ of plons, occurote plot ~on to ~ole. Fee occo~ing to sch~uZe. b. Plot plon showing Iocotio~ of lot ond of buildings on premises, relotionship to odjoinin oreos, ond giving o detoiled description of IQyout ofpr~e~ must be drown on tbe diogrom which is ~ of this opplicotion. c. ~e work covered by t~is opplicotion moy not be comme~ed before issuonce of Building Permit. d. Upon opprovol of this opplicotion, t~e Building Inspector will issue o Building Permit to t~e opplico~t. Suc~ permit s~oll be kept on the premis~ ovoiloble for inspection throughout the work. e. No building sholl be ~cupied or u~d in whole or in po rt for ony purpose whotever until o Ce~ificote of ~cuponcy sholl ~ove been gronted by the Building Insp~tor. ~PPLi~TION IS HEREBY ~DE to t~e Building Depo~ment for the issuonce of o Building Permit pu~uont to the Building Zone O~inonce of the Town of Southold, Suffolk County, New York, ond other opplicoble Lows, Ordinonces or Regulotions, for the construction of buildings, odditions or olterotio~s, or for ~movol or demolition, os herein d~crib~. T~e opplicont ogrees to comply with oll oppficoble lows, ordinonces, building c~, h~si~ c~e, ond regulotions, ond to odmit out~orized inspectors on premises ond in buildings for n~esso~ inactions. (Address of oppllcant) t~/~,,-?b- %~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~.....~~ ........................................................................................... If applicant is a corporate, signg, ture of duly authorized officer. - (Nal~e and title of corporate officer) Builder's License No ......... ~.../. ...................................... Plumber's License No ..... ./'~..~.../.....-......?. ...................... ~ Electrician's License No .... r/.~..~....~.......~.'. ........... Other Trade's License No ............................................... ~1577, /o,~ c~ 1. Location of land on which proposed work will be done. Map,No.:-,~...kT.--~....?.'......~..?...~....~..~.Lot No. Street and Number ~.~.../?l..it,'J.~'..~/D.~,..,I ............. t~,~.~...~./.~..~.. ........................................ ,~...~...~..~..~...~..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 .......... .~./~/..k(..~..~.....,/~..~..../~..~,,/.4~.~,, .......................................................... 3. Nature of work (check which applicable): New Building · Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~ 5-" (Description) 4. Estimated Cost ..........................................................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 ..... /. ..................................................................................................................................... 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 odditions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~.6~.....~, ................ Rear ...,..~.~...-..~,.../,.~.... Depth ...~.~. .............. Height ,,~'.~, .......... Number of Stories ........ ~.. ......................................... X ............................................................... 9. Size of lot: Front ........ ./.~...~....~ ................................... Rear .........~.~.~.. ....................... 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 pr,e~nis, es: ().), Yes ~ No 14. Name of Owner of premises ~./~f,~.: ...... /,,s~.~ .......... Address ~,~.~..~ Phone No. ,J.,~..-..~...~.~..~3., Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM 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 t° deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ¢ ¢ COUNTY OF ...,S.t~rJ~g~lJ~ ............ ~'~'~ .... ~.]~p,~,.~l~.~J3.O. ............ ~ ........... being duly sworn, deposes and says that he is the appJiconl (Name of individual signing contracf) obove named. He is the .................................... .{t.g.~JL~,..~.QJ;...~g~.t;,~.iJ.¢.~;.Q3~ ............................................................................................ (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 ond file this application; that all statements contained in this application are true to the best of his knowledge ond belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... ZS.~n- ..... doy of ...~'Q.v~a;~e=. ..................... , ]9....7.7. Notary P.ublic, . ............. ~I,I,:[~,~Q[_.~ ...... County No. 52.8125850, Suffolk Coq~ty~/ Term Ex~ires March 30, 19 (Signature of applicant) I