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Home My WebLink About6989-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at North Rd &. Go~..d.~.n..L.a .... Street MapNo. N.. G, oldi.n BlockNo ....... LotNo. 13 & I~ Southol4 ~.Y. conforms substantially to the Application for Building Permit heretofore fried in this office dated Nov 16 , 19.7.~. pursuant to which Building Permit No..f.~.~9.?. dated No.¥.. ~.6 , 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 Btlsi.ne.s.s .b.u.ilding & apartment with acce~sory (storage) bldg Arnold Ls rsen Owner (owner, lessee or tenant) The certificate is issued to of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No.n:?.· ....................................... HOUSE NUMBER ~.2.22.~.... Street !¢.o.z:t..h. ?.o. 9.d' .(.C..R.2.7.). ..................... Building Inspector / TOWH 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.o 6989 Z Date ............................. , 1 Building Inspector. Fee ~.,.' ................... FO~ NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N, Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcahon must be filled m typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildmgs or new use: I. Final survey of property with accurate location of all buildmgs, property lines, streets, aha unusual natural or topographic features. 2. Fmal approval of Health Dept of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical mstallation from Board of Fire Underwriters 4. Commercial buildmgs, Industrial buHdmgs, Mulhple Residences and similar buildmgs and installations, a certificate of Code compliance from the Architect or Engineer responsible for the buildmg. 5. Submit Plannmg Board approval of completed s~te plan requirements where applicable. B For existing buildmgs (prior to April 1957), Non-conformmg uses, or buildings end "pre-existing" land uses' 1 Accurate survey of property showing all property hnes, 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 hous,ng 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 Buildmg ...~. ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........ .~::~......~..~.-¢'~..~..I.~.'..~.~-~...~...~.~__ ................ Owner Or Owners Of Property .... ~~-~,_..~~ ........................................................ Subdiv,sion .....~.~.x~..~....~,~r~ .............. Lot No.~..~..~. Block No...'Ti. ........ House No ....-TT ..... ..... .................................. Health Dept. Approval ...... ~..~...~..~ ......................... -a~or l~pt Approval .......... .~..~.~...~ ....................... Underwriters Approval ..... ~..~....~.. :: ....................... PlanningFBo~Jrd A~roval ......~.v~. .................... Request For Temporary Certificate .~ ...................................... ina Cert't'cate .......................................... Fee Submitted $ ..... ~.C?..~ ................ Construction on above described buildmg and permit meets all applicable codes and regulations. Applicant ...... ~ ...................................................... ora Public . ~. ~. _~. JUDITH T BOKEN N :~ '~ ."'~"--. .......... "~otaw Pubhc, S,ate of New York ~~~~ No 52-0344963 Suffolk Count~( FOR~[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Disapproved o/c .......................................... : .............................................. (Bull~lhg I'ng'pector) SOUTHOLD, N. Y. 19.Z..'~. No. ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcot~on must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildin Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan s¼owmg Iocat,on of lot and of buildings on premises, relohonsh~p to adjoining premises or pubhc streets · areas, and gw,ng a detaded description of layout of property must be drawn on the diagram which is part of this applicatior c. The work covered by th~s application may not be commenced before issuance of Building Permit d. Upon approval of this apphcotion, the Building Inspector w~ll ,ssue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or m pa rt for any purpose whatever until a Certificate of Occupant 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcoble Laws, Ordinances, Regulations, for the construction of buddings, additions or alterations, or for removal or demohtion, as herein descri~ec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and r~lations, ar)o~i admit authorized inspectors on premises and in buildings for necessary inspections. {~--'"~ * ~e o~plica~ n~ne,'"~f a c~ratio, n) ..... ...... (Address of applicant) ~,~ ~ State whether opphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde Name of owner of premises ................................................................................................................................. If apphcant ~s a corpt~a~ s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No .................................................... Plumber's License No ................................................. Electrician's License No ............................................ Other Trode's L.cense No .................................... ~'"'"~'" Ma No~' Location of land on w~Lg, h proposed, woj:lr~w'~LL ~e ~ el ,~ap : .... ~.w..= ........... ~... L~o ........ ~ .~_~. Street and Number ~~....~~~~..~.~.~. ......... ' Munici iJ State ex~shng use and occupancy ~remises and mtende~ use and ~pancy of pr.oposed constmctiop: o Exisiting use and occupancy-~fk~- ,nte.ded us a.docc. .c ................. ........... 7 .................................... [ ............................................... 3. Nature of-work (Zheck wh,ch applicable): New Building .................. Addit,on ............... Alteration Repair .................. Removal .................. Demohtion .................... Other Work ............................................ (Descriphon) 4. Estimated Cost ........................................................... Fee ............................................................................ (to be prod on filing th~s application) 5. If dwelling, number of dwelhng units ........................... Number of dwelhng umts on each floor .................... If garage, number of cars ............................................................................................................................... 6 If business, commercial or m,xed occupancy, specify nature and extent of each type of use ............... 7. D,mensions of ex,sting structures, if any: Front ....... .']..~... ............ Rear .......... ..-~'..~...'~.. ............ Depth ..2~Z) ........ He,ght ........................ Number of Stones ....... ..~..t.~..~,., ........................................................................... Dimensions of same structure with alterations or additions: Front ....~..~;~m-~.e~. ..... Rear .................. Depth .............................. Height .......................... Number of Stories ........ i ..................... 8. Dimensions of entire new construction: Front .... ' .... .~..~:~ ................. Rear .......... .%..<;:D ......... Depth .....%....'~-. ..... Height ...~.~ ........... Number of Stones .......................................................................... 9. S,ze of lot. Front ............ ['.~,~ ................................... Rear ............ .~..~. .................... Depth ......'~.~ .............. 10. Date of Purchase ................................................. Name of Former C~wner .............................................. 1 1 Zone or use district in which premises are s~tuated . .'~O'~t..~$'.~ ........................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation .............................. .....~/. .............. 13. W,II lot be regraded ...... .~'h~..~x ............ Will excess fill be removed from premises: ( ) Yes (/V~ No 14 Name of Owner of premises ...(~.~.'a~.~,-.,~~i~Address .'~.~C'/9~L~.~..... Phone No.'~.~.~Z~.~._- Name of Arch,tect .............~..~.~.?.. ......................... Address ................................ Phone No .......~.~ ............. Contractor ........... ..~'..~'-' ........................... Address ................................ Phone No. Name PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions from property lines Gwe street and block number or descnpt,on,~-'~'~vding to deed, and show street names and red,cate whether interior or corner lot STATE OF NEW ~RK.,~ d~_ [cc COUNTY O~ ............................................................................................. bmng duly sworn, deposes and says thot~phcant (Name of indlwdual signing contract) above named He ~s the .............................................................................................................. ..~ .............................................. (Contractor, agent, corporate office.) of sa~d owner or owners, and Js duly authorized to perform or ~erformed the sa~d work and to make and file th~s apphcation, that all statements contained ~n th~s ~f h~s ~owle~ behef, and that the work will be performed in the manner set f~io~led therewith. Sworn to b~f~e me th~s (' ~ s / ' ' ...... ...... ~ ~ (Signa~ ~ ap~l~ NoloW pubbc, ~tato of NeW York ¥1o 52.0344993 $uffoJk CoUn~ . ommL~'~q Lxptles h~arch 30, tJ Z 0 I 0 0