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Home My WebLink About7137-zTOWN OF $OUTHOLD BU~'.n]NG DEPARTMENT Town Oerk's O~ice Southold, N. Y. Certificate Of Occupancy No.Z.6.8~7 ....... Date ........... ~D.e.o .....22 ..... , 19. ~.~ THIS CERTIFIES that the build~glocated at . 5~.S. l~a~ll. Roa~ ........... Street Map No. xx .......... Block No...xx ...... Lot No. x~.. · Southo~d. · I~,Yo .......... confOrms substantially to the Application for B~d]d~ng Permit heretofore fried in th~.~ office dated ............... J~.22 19.~. pursuant to which Building Permit No..7.13~Z · dated ............. l~a~..~., 19.7.~., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which th~.~ certificate is issued is .N~d · o~upancy. ~tore. & .D~i~;I~. w~th. add~t~om ................ The certificate is issued to ~&,~J~ .~,. ltotll~ ....... ~ ....................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . .N,R, ............................. UNDERWRITERS CERTIFICATE No..p~d~n~. .. HOUSE NUMBER...~ 80 ..... Street.. l~$n. ~t~®e~ .......................... ..... ......... Bui]dlng Inspector ~ FO~.M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7137 Z Date ........................... J'~'a,l~C ~ ....... ~....., 19~14.... Permission is hereby granted to: Geo~,~e...M~-Z.e~...~du.i.~d~..~me...~/~...~,o.t~n Dept store (D,A.R) .......... Cu.tcl~.o~ue ................................................ ~l~..axl..&dd-~ ~tozm..o~..ax£s f~tng ..mlxe~..~c ~upanc~...£1~ sine~ s.. ~.~e~t~ene e ) at premises located at ~/.~ ....... ~'~..~g,d .......................................................................................... .............................................. ~1~1'~0 *~ ~. .............. [~.eX,J. ....................................................................... pursuant to application dated ........................... .t...~..2~,~.~..l~. ...... , 19 ........ , and approved by the Building Inspector. -- ' 'i~il~i~g Inspector / ................. FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 Hoalth 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 New Building ................ Addition ..~ ............ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Main Road, Southold, New York Owner Or Owners Of Property .M.r.. Robert Rothman Subdivision ................................................................ Lot No ............. Block No ............. House No ............. 3/26/'74- , George Ahlers, Builder, Inc. Permit No...7. ,]:.~.7.. ......... Dote Of Permit .................... ~ppiicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Electrical work done Underwriters Approval ...b~r...o~'l~'~ ........................ Planning Board Approval .~O...D~l.~[I,l~,~ ............ Request For Temporary Certificate ........................................ Final Certificate J Fee Submitted $ ......~.. ............................ Construction on above described building and pe~it meets all applicfib, l~ codes and regulations. AppI,cont ....... G~ORG~. ~.RS, BU~:~b~','"'~:~f~'~ ............... Sworn to before me this ~ ~ /~(~ ~ ................~ ~'oay o~' ............................................ ~ ~ [ f > ~ (,t~mp or ~) ~ ,~f/~ ~7 Notary Public .......~ County SOUTHOLD, N; Y. Disapproved a/c ~ ..................... ...... .......... INSTRUCTIONS TOWN OF SOUTHOLD '~..,(,.~~ ~ ~ ~ "UILDIN~ DEPARTMENT Town a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Buildina.'~ Inspector, with 3 set~ 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 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 Buildi~ Permit to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the work. e. No building shall beoccupied 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 alterations, or for removal or demolition, as herein described. The opplicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. t~:gna~ure-ot appficant, or name, if a corporation) (Address of applicant) a' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner'of premises .../~..(~~~~ ....................................................................... If~.,~ a corporate, signature of duly authorized officer. ......... Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which_propo~d work will be d_qne. M~p ~ ................ .~ ..................... Lot No ......................... Street and Number ,./~...~:;:~. ...... :~f~.~... ........................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~....~C~/.../~....~.--......~...... b. Intended use and occupancy ..e~7~/~"~ ~//'~ ~/-~ "-"- ........... C~.~...~:..~..C'.._______________~.~.i...17...: ............................................. whether interior or cpmer lot. . (check il i ................ n ... ion .................. Repair ............ i ..... Removal .................. Demolition .................... Other Work ................................................ . (Description) 4. .mated cut'. ...... ..................... 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 oflsame structure with alterations or additions: Front .................................... Rear ............................ Depth ............ ' .................... Height ............................ Numbe. r of Stories ................................ ~ Front ~...~...../ Rear ..../..~... 8. Dimensions~F/entire new construction: ............ .............. ................ Depth ............... Height ..... ~..~'...; ......... Number of Stories ......... ~ .......................................................................................................... 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 reg~aded ............................ Will excess fill be removed from pre, mises.~( ) Yes ,_~ (~"~'No 14. Name of OwneI of premises .~.,~.~,...~>~.. AddreSs/~.[.,~(~t~...-5~..7"~..~~ No ....................... Name of ^rchitect .......... · ......................... : ........................ ^ddre.~ ................................ Phon, No ....................... .................... .o. PLOT DIAGRAM Locate clearly end distinctly oll buildings, whether existing or proposed, and indicate all set.ok dimensions from property lines. GiveI street and block number or description according to deed, and show street names and indicate ADD'~'rJ e~ STATE OF NEW 'Yq~R~ .~S.S COUNTY ~:a'~e o~: i' ......................................................... being duly sworn, deposes and says that he ,, the applicam He is the ............ I....'~ ........................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or Owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all 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 fodh in the application filed therewith. Swam to before m~ this ' "~plicant) ......................... Notaw Public, . ................................................... C~n~ ........................... a //'