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Home My WebLink About10055-zFOKM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Occupancy No. Z9332 Date December 8 19 78 THIS CERTIFIES that the building located at . .1.~..~.0...C..lp.a..r~..i.e.w..A.y.e .... Map No .... .4??0 .... Block No ........... Lot No ........ ~. ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .December....~ ....... , 19.78. pursuant to which Building Permit No..10,0.~.SZ dated .Dewoembe.r.....5 ....... , 19.78, 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~..v..~.~.e..O~.e..F..~.... Dwelling /completion of Second Floor The certificate is issued to ........ O~.~,q, .S,. ,&.. ~,o, ,a~., .E.., .S.i.n.F..a~.. .................. (owner,~.~ of the aforesaid building. Suffolk County Department of Health Approval ............. 1~../.R. ................... UNDERWRITERS CERTIFICATE No ............ N412~l ........................ HOUSE NUMBER 1~0 Street Clearvtew Ave ........................................... f ................ County Tax Number 1000-070-9-55 ~OE~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10055 Z Permission is hereby granted to: . , ./~,q~_~ .. ..~...~~..~.~.~...~,:,..,~.,.,.,~.~., ..... ~.~...~.,~.,.:.. ............................................ ........ ~.o..~.~o ~.~ ~ ........ ~ ~. . ~. ....... ~o ...6~.~/~.~.....~:~.~.~....~g~.~....~xzz. z~..~ ........ ....... ~.~.~4.~..~.~..~ ................. ~ ........................................................................ ~ .~. .............. ~,x~zz~....~ ~/~ ..... ~ ~.. ~. p.r..~.t to ~pp,=~o. d~e~ .... ~e.... .......... X ....................... , ~, ~.d ~ppro~ by ~he Building Inspector. ~e~ *./.~,...~ ..... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 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 featu res. 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. B. 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 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 informa- tion 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 Date ~omh~r.7.,..197~ ...... New Building ............. Old or Pre-existing Building ...~ ........ Vacant Land ............. Location of Property 1330 Clearview Avenue Southold~ New York House No, Street Ham/et Owner or Owners of Property , .0.~.o..~,t..~.~.~.. ~p.a..n..~....S..~.~.~..e~..m .......................... Clearview County Tax Map No. 1000 Section . .~?.?.0 ......... Block A.¥.eP.~.e. ........ Lot... ~. ........... Subdivision Smithfield Park .Map No. Lot No. /.6~ ~..o~..Z. Date of Permit/.,~/,~,~/,'[~¢..Applicant..G.ep,~ .e..A.~.~..e?.~, ~..~.~.~.~.~..e?~..~.D.c... Permit No. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ............. - ...... · .-.-...Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... Z ............... Fee Submitted $....O~,.~2.~. ..................... Construction on above described building and permit meets al~ applicable codes and regulations. Rev. 10-10-78 Applicant George Ahlers~ Builder~ Inc~ ....... TOWN OF SOUTHOLD. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. LLZ. f~..~.~.. ........... D' isapproved a/c ........................................... (,<~. ............................... / ......... ::? /[Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........... .De~eml~ez;...~.y .......... , ] 9....7.~... 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 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 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 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 o 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 in buildings for necessary inspections. .... ~.0J~GE..AH~.R~., ....9.~ .Z.~.:9.~L~:,.....Z.~g.... ......................... (Signature of applicant, or name, if a corporation) 250 Cox Lane .... Outc~zog'cte.v.-[~,e~,..¥e~]~.....~.1.9..D .~ .............................. t/~aaress orapplicant) State whether app]icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ .......................... G'e~'e'~':~" ~ont ra'c to z' ............................................................................... ~2' .......................................... Nome of owner of premises ....... Otto-"S';-"~:L:r~'/...'J~/',:T~n...D;...,G~.n.r~ ........................................................ If applicant is~ corporate, s~c~uf~/'?f duly authorized officer. ................. ~~ .......... ~'~'"~'") .................... Oeor,~e Ahler~, President (Name o~ title of corporate officer) Builder's License No .............. ~.]. ................................... Plumber's License No. ./,1.9.3,~ ..................................... Electrician's License No. ...~.-~.9~ ............................. Other Trade's License No ............................................... Location of land on which proDosed work will be done. Map_~....~t ...................... ~kot No.....~,~......5 .......... Street and Number ........... ......... " Municipality State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ............... ¢j.~e.'t~,~.13~..'TT .... O~,~.-.....~..~..~.~...~ ................................. b. Intended use and occupancy .,,~,~.,~....'~.....~./~'.~.,~/~..~..~-~/~.~'.....-.~.¢~,,,-~....~4~..~.'~ V . expan .o 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ...~.~..~.~ .. Repair .................. Removal .................. Demolition....: ............... Other Work ................................................ ,',.~j~ ~ (Description) 4. Estimated Cost ...... ~~ ............................ Fee ...&~ ................................................................................. 7 . (to be paid on filing this app ication) 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 ..6[.~ .................... Roar ...... 6.~, ................... Depth ....~,~ ......... Height ........................ Number of Stories ....~. ........................................... ~ ............................................................ Dimensions of same structure with alterations or additions: Front ..... Be~e ...................... ~ Rear S~ ................... Depth ....se~e ................... Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ; ........................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................... ~ .............................................................. 9. Size of lot: Front ...............: ........ ~Q~.~.~ .................... Rear ........ [~.¥~[. ................ :.. Depth ..2~.~.i~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 regulatiom ~ ................................................... 13. Will lot be regraded ............................ Will bxcess fill be removed from premises:'( ) Yes ( ~ No 3o 1 4. Name of Owner of premises ~¢o...S.~./~e~..~',~...~ddress ~[e~e~...~e,Phone No ....................... Name of Architect ............................................... ., .............. Address ................................ Phone No ....................... Hame of Contractor ~eO~.e..A~[e~.S,~[~.~...~dress ~.~..~,.,.~~ ~ ...................... 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 to deed, and show street names and indicate whether interior or corner lot. NSW . _.,TY OF ........ f ' ~ame of individual signing contract) above named. He is the ................. ~~~ .......................................................................................................................... (Contractor, agent, corporate officer, eta.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th s app cation; that ali [tatements contained in this application are true to the best of his knowledge and belief; and tha~ the~ork will be perf~(med in the manner set fodh in the aRplication filed therewith. Sworp~ before me this/Il Nota~ Pubhc, ~ ~un~ -,x4 ............... ............................. ~ /'"" " -~ ,, ,. ,,. , ~ :~ ~ ~', ~ " ~.. ;'E~~ ~" ,./" ; . ',-.' " NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM F~ R~QUIR. ID INSPECTIONS: ~ DEFORE DACKFILL~NG FOUNDA- T~O~ OR START FRAMING ~- ~FO~ COVE~NG ~S OF AN% K~N~ 4. FIr~AL V4H~N JOD COMP~TED ' NOT RESPONSibLE FO~ DESIGN