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Home My WebLink About10054-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No... 29625 ......... Date ................... Auguat .9 ..... 19 7.9 THIS CERTIFIES that the building ................................................ Location of Property 55. ~.;~.o.'1;I~, R.d,~. ~<..~.60. vT.e.n~$ng~ .Rd ........... So.thole. ....... House No. Street Hamlet County Tax Map No. 1000 Section . ' .05 .~-. ..... Block . 7 ............. Lot ...12, ............ Subdivision O~kridga .I~il2.s .............. Filed Map No...3~t55..Lot No..1 ........... conforms substantially/to the Application for Building Permit heretofore filed in this office dated ·.. D.e.c,./.t.. .......... , 19 Y[]. pursuant to which Building Permit No .... 1005.~Z ........... dated .De, ce, tuber. :~ .............. 19 [~., 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 ......... .... ;gz:zYa.~.¢.. o~-~..famz.ly, dw. el!i~ ........................................... The certificate is issued to ................. Eletla. Be ,z'.ga~ll ........................... of the aforesaid building. Suffolk County Department of Health Approval 8.-SD.-.I~.'~0.,..?/23./7.9~. Ro'ber. t .A,. Xilla. UNDERWRITERS CERTIFICATE NO ........ N..&A.206.& ................................. Rev 4/79 ... ?..-.~f~'~.~: .~.~ ............. Building Inspector FOI~H NO. 2 TOWN OF SOUTHOLD BUILDING 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? 10054 Z Permission is hereby granted to: ..~c. ....... ~ ~.~:.....::~ ...................................... ~.~.~.~..~.~'/ ..... ....... ~t..~..:....~.,...~. .......... ~. -- ~' ~ at premises located at .~/~... ~.....:~,~.(~;::..~2.~.....~Z~i~.t ...... ..... : .............................................................................. ~:~o~.~.=..~.:~:-- ....................... pursuant to application dated ....... ~,. ........ ~ ..................... , 19_ .~ and approved by the Building Inspector. Fee $.~.~..:Z~..~ .... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. 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 . 7.-~.~.-79. ................ X New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property cp~.]~er..Q£, Bo.arb. Raad. ~L~d. J~z~uings .Road,. So.utho~d,. N...Y,. · House No, Street Ham/et Owner or Owners of Property Elena Bergani County Tax Map No. 1000 Section . 05L~ ..... Block .7, ............. Lot... 12 ......... Subdivision.. O,3J~:~'±dg.a .~i:]-ls .............. Map No..3555 ......... Lot No... 1 .......... Permit No. :L005.~, .Z.. Date of Permit .Dec. ~5./7~,pplicant ...Gea~ge. ~ler.s .]~.~ ~,der~..Iz~¢. Health Dept. Approval ?/~'-~/;~' . Labor Dept. Approval Underwriters Approva~ ?.~,~.~.2. ?...~'..~..Z~.Z.~. ~.~/., .Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...X ................... Fee Submitted $ 5 · O0 Construction on above described building and permit~ts~., ~l/ppl~~nd regulations. Appl mant ....... .,~'~L-"~., ." .~,~- ............ Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- pHI BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~ly t~ el~t~al equipment ~ ~cd~ ~ and in/~u~ by t~ ~pl~ant ~ on t~ a~ ~pl~at~n numar i~ t~ p~m~s C~aeh~Be~anX~ Jen~n~s Rd. off Ho~on Booth Rd & Dead End, Sou~ho~, L.I. w~,~i~do, July 16, 1979 and found to be ln ~mpliance With the requirements of th~ B~rd. RXTURE FIXTURES / 33 '17 [ RANGES SERVICE DISCONNECT NO. Of METER R COO~!N~.~,[ ~r0VEN~.S~. I~.SMT, WAE..HwInS C 1/0 NO. OF HI-LEG OF HI-LEG EXHAUST FANS DIMMERS AM, Ti WATTS I 1/o 2-Smoke Detectors OutLaY Ba~tma 227 East Bmeakwater Rd. Mattttuck, N.Y. 11952 Per ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be id; COPY FOR BUILDING DEPARTMENT. THIS COPY OF CIRTIFICATi MUST NOT BI ALTIRID IN 765-;L802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [/~FINAL REMARKS: T~'L. 765-266D TOWN OF SOUTHOLD OFFICE DF BUILDING INSPEOTOF~ TOWN CLERK'S OFFIOE SOUTHOLD, N. Y, 119'71 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. ×am ned ................. D' ~ ~ ...~. ~sapproYed a/c ................................................. ~. .............. ~. ................. -- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building In~spector, with 3 sets of plans, q¢curate plot plan to scale. Fee according ¢o schedule. b. Plot plan showing location o. f4ot and of buildings on premises, relationship to adjoining premises or public streets o~ 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 appticatioQ may not be commenced before issuance of B~uilding Permit. d. Upon approval of this appliCc~tion, the Building inspector will issu~ 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' 6Iterations~, 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 name, if a corporation) Cox Lane, Cutchogue, New York 11935 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General contractor Elena Bergani Name of owner of premises .................................................................................................................................................... if applice~,isa corporat~n~4~ure of duJy authorized officer. ........... ...,~...~...~f..d~...~.~4~ ......... %~ ........................... George (Namf~)and title of corporate officer) Builder's License No ........ ..~..3: ........................................ Ahlers, President Plumber's License No .... ~.7.7.~ ................................. Electrician's License No. ~..9...~. ................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map N.o.: ....;..~.~.5~..~ .......... -.; ......... Let No..]. .................... Street and Number ...C...°.?.~.e..~...o...~.....B.o.~).'~..~.....~...o..a..~..a...~.¢...C..e....z2,~...~....~..o...~.~.,....S..Q.?...t;;...~..o~¢.,.. ~!~ ............ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: e. Exisiting use and occupancy ........ .~.~..~.~'./,~.. ......... ~-.~.~.~. use and occupancy .............. ¢,.'kc..~.~J,~g...:...~.....~.....¢~.../.¢.¢~...~......~..~...~....~.~.'./'~...../..~..~...~_Z~-- b. Intended / / .3. Nature of work (check which applicable): New Bui!ding' ...X ............. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimai'ed Cost .~..5...Z. ~..0...0..0.. :..0...0. ........................... Fee~-.~. ~ (t~) be"~[~"~'~"~'i'li'~' t~i'~"~'pplicatic~r~) ..... 5. If dwelling, number of dwelling units ....1. ....................... Number of dwelling units on each floor..i: .......................... 2-oar e If garage, number of cars ......................... .~..~..~0~5.~. ....................................................................................... 6. If business, commerdal or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~0.! ................ Rear ..~01 ......................... Depth 2_8,? ............... Height .1..~..T..~..a...r..i...e..s.... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8~ Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......... :~.,~.-~.-......~.~,~...~.. .... Rear .......................................... Depth ................................ 10. Date of Purchase ............................................... L ........ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......... A, ........................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ X~ ........................................... 13. Will lot be regraded ..... y..e..s.. ............... Will excess fill be removed from premises: ( ) Yes ~c ) No 14. Name of Owner of premises E::Len~ B..e..r. gytn.i. ................. AdcLr, ess 3.],]~..]].e,~,,,f',qZ'.cl, ...... Phon~ No.~)~...~q'l .... .......................... ~art~ ~±vm. ,t~ronx Name of Architect .............................................................. Address ................................ Phone No ....................... Name of ContractorC}.~o~g~...Ahl.ar.~.~.B.ui'l d~r .......... AddressC~X...L~,..~ .............. Phone No.7..3~...,~.'!.O .... PLOT DIAGRAM Cutohogue, NY 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 ~hether interior or corner lot. (see attached) COUN-rY OF ....... Geo~/~.e..?..B,.~.....~.re~'i ct.e~t be n duly sworn, deposes and says that he is the appHcam (Name of individual ~sig~ing contrac0 ~ c~ ~ above nome& He is the ...................................... q~.~O.~D.~ ................................................................................................................... (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 tha~ the work w~ll be perform~ in the mapner set forth in th~applicotion filed therewith. Swornto~me~ / II / ~ ........... y ................... ........ ........................................... ~,,,:t~-,. ~c ~ L"~ 7 (Sig%~ture OT applicant) SUFFOL,K CO. HEALTH DEPT. H.S. ~O. ~- ~ P~o~~ ~AT~M~NT OF INTENT ~ ~/:~m ~, /., /~ THE WATER SU~LY AND ~WAGE DIS~AL --'~ ~:~~1 *j~._ SYSTEMS FOR THIS RESIDENCE WILL ............... CONF~M TO THE STANDARDS OF THE SUFF~K CO. DEPT. OF HEALTH SERVICES. 1979 ~." :~'~. ~~ SUFFOLK COUNTY DEPT. OF HEALTH, SERVICES -- FOR APPROVAL OF ~ .... ~ fou':d DATE: ,atl~..ct~ry . ~ A~ROVED: SUFFOLK C0. TAX MAP DESIGNATION: ~o~ l~ O~ ~ GREEN~RT N~ YORK SUFFOLK CO. HEALTH DEPT. APPROVAL h.S. NO. ~!~ !P~!,~i tJF ~iE~LIH ~EO~C-.E /~HLER5 J ~50 COXS LANE NOV t0 Pt~ .3~9 ~ ~*- CUTCHOGUE, N. Y. 11935 ~ ~ ..... F K.V~:-~.=~'. . ::-~_.,=-v?_'., ~-~¢~ STATEMENT OF INTENT ' ' ..... ~ ..... THE WATER SUPPLY AND SEWAGE DISPOSAL 5~', ~-~ ~ ¢ ,:- : ....... -,. ,~.~e" ~, -,,' SYSTEMS FOR THIS RESIDENCE WILL ..&~ CONFORM TO THE STANDARDS OF THE .... c. : I SUFFOLK COUNTY DEPT. OF HEALTH [ SERVICES-- fOr APPROVAL Of CONSTRUCTION ONLY DATE: ,~[~ H.S. REf. NO.:~ ~0 APPROVED: DIST. ~CT. BLOCK ~L. ~ ~ = /Kor~ ~F~ OWNERS ADDRESS: J - H~cx ,._~ ~A~ .',lc'.''~ ="'~ ~ SEAL R~RIF~ VAN T~. P.C. GREEN~RT NEW YORK APPROVED AS, NOTED NOTIFY BUILDING DEPARTMENT AT- 765-2660 9AM fo 4PM FOR REQUIR- ED INSPECTIONS: I. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING PIP~:S OF ANY KIND 4, FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING f/