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Home My WebLink About6427-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 6427 Z Permission is hereby granted to: ........ D. ep.a~,..La .................................................... ............. G.~a %e.hc~g~e ............................................. to ~i~..a~..adr~.ti~..~..~ake..~.te.r~n~..~n..e.xi.s~.Tn:g..~.~1.g. ................. at premises located at ..lo.t..:Jh ....... ~V~T-.~ne..:~ee.~:by .......... i' ..................................................... ............................................. .G.'t en~o~...~d- ....... F-l'ee'~s"-B~ck[' '~atc'ho'~u'~ .............................. pursuont to opplJcotion doted ................... .~[f~.i~ .......... ~.~ .............. , 19~,~,..., und opproYed by the Building Inspector. Fee $ J.~.e.~.0. ........... ! ~ Buildir~g Inspe~or TOWN OF $OUTHOLD Building Depa~ment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructinns A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new us~: 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 disposol--(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 u~es, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing oil 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 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 or premises, or other pertinent in- $5.00 3. Copy of certificate of occupancy $1.00 Date..~.'Z.~./?.....~. New Building , Old or Pre existing Building ~/// i Vacant Land ................... - ........... ' ...... : ........... ..... Location Of Property ......... ....... ........ ..~....~......//...~.......~....~..?./..~.~,//2'o~/ Owner Or Owners Of Property ...... ..~..~..~.~.~.~../~...~....~..~.!....~...K..(..!~...O.~..: ................................................... Subdivision ............ .,~.~¢~../~.~,..~.~X...~?......~.~.,J;~..Lo' No. Block No ............. House No ............. Permit No..~....~...~.,~.....'~... Date Of Permit .~.f.~..?.~.?~.'.,..AppJicant .~. · .~. J, .~;,. · .~- ~Q: .......................... Hea~th Dept. Approval ............... ,~...! ....................... Labor Dept. Approval ................................................ Underwriters Approval ............................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ ................. Fee Submitted $ .~.~. .............................. Construction on above described building anti, p,er~mj$ meets all a~plicable codes and regulations. Applicant ~ ~.~,. ,~~..~.%.z. ~..~..~.~;~c~ ............... ~ .............. Sworn to before me t~h~ TOWN OF $OUTHOLD Building Dep~r~ment Town Clerks Offi~ Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF ~CUPANCY Instructlons A. T~is ~ppl~ca~io~ mus~ be fill~ ]~ t~pe~ri~er OR i~k, and submitted Inspector with the following; for new buildings or new use: 1. Final su~ey of property with accurate I~ation 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 Unde~riters. 4. Commercial buildings, Industrial buiidings, 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 utes, 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, ~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pe~inent 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 Building .................... Old or Pre-existing Building .,.~....~ ........... VacantlLand ............................ Location Of Property ~).~.~..~.~.~ ........ ~,~¢~...~,. ~ne, Or ~ners Of Prope~y,,'"~¢~'4Y~'""4:;'"'~8'"~;'¢/~5" '__ __ , _,,,, __. ~ ................................................ Subdivision 1~'~'~¢~'"'t~*:~"~'7 .......... Lot No.'/"~"J" Block No ............. House No ............. Permit No ..................... Date Of Permit .~E/:~,~../.., pplicant ..//~..:. ........... ~)....~ ......... .~.. Health Dept. Approval ............................................ Labor ~pt. Approval .............. ~.~ ....................... Underwriters Approval~ ~ ~ .......... ........................................ Request For T~mparary Ce~ificate'// ........................................ Final Certificate .......... ~ .................... Construction on above describ.d building and permit ~eets all applicable codes and regulations. Sworn to bo{oro me ["'1' day of ..... ~1 ............. >. (stamp or seal) Notaw Public ..........~/ ....................... County 1,4 AT T¢~vv'~ OF .S~U'T'~,...O, N/.~/.