HomeMy WebLinkAboutZ-7404FO~ NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificete Of Occupancy
No.Z?.I~. ....... Date ............ D. eo.. ~, ........ , lg~.
THIS CERTIFIES that the building located at . 8/.8. Sage. lkl~ ........... Street
Map No..xX .......... Block No. , .x3r. ..... Lot No,
confoms substantially to th~~~~~
Bldg
b~.. ~for,..A~'. 2~ .... , 19. ~7. p~suant to whic~~
dated ......... Dee...~ ...... , l~b., was issued, ~d confoms to ~ of ~e req~
ments of the applicable provisions of the law. The occupancy for which ~is certificate
issued is .I~trlal. b~ld~g. {b~ek .b~g). & .leee~so~ .(vo~e~. hoar. ~ed)
The certificate is issued toH~a~ .& D.O~O~.. Z~e~ ....... ~er~ ..............
(owner, lessee or ten~t)
of the ~fores~id building.
S~olk County Dep~tment of Health ApprovM ~. ~S~ .....................
UNDEBWBITEBS CERTIFICATE No..p~,, ~x~s~ ............................
HOUSE NUMBEB ...q~ ....... Street .. 8~e. B~ ..... 9re~po~.t · (B~thold ,~ )
FO~M 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 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), No~-conforming uses, or buildings and "pm-existing"
land uses:
1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural
or topographic featu~s.
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 promises, 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
Date Dec. 3 1976
New Bqilding ................ Addition ................ Old or Pre-existing Building ...~ ...... Vacant Land ..............
Location Of Property ..... .~.../.~...~.~..~?.....~...1.¥.~. .......... !..~..?.~.~..e.r..~..~...~.~...g..e.....~.~..~.~.....~.~?...~.] ........................
Owner Or Owners Of Property ..~..o...~.~..~..~.....~.....~..o...~.~.~...~.~....~...e..~...~.~..~. ..............................................................
Subdivision ......... .~...~. .................................................. Lot No .....2L~... Block No.....~... House No ....... ~.Z60
Permit No .....~ ........... Date Of Permit .,.,.-~ ........... Applicant .....~....~....~....~.,~ ..~...e..~. .................................
Health Dept. Approval ........ ..~.?..~. ............................ Labor Dept. Approval N.~.
~nderwriters Approvol .......... ~.~ ............................. Planning Board Approval ..~ ............................
~equest ~or Tempora~ CertificQte ........................................ Fin~ Certificote .......~ ............................
Fee Submitted $ ..~..:.?..?. .........................
Notary Public ............ .~...u. ~..~.~. ~Z~. ....... County
Construction on above described building and permit meets all applicable codes and regulations.
Sworn to before me this check 12/3/76
c/o z74o
(stamp or seal)
Receipt
122 51