HomeMy WebLinkAbout6428-zFORM NO~ 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Sonthold, N. Y.
Certificate Of Occupancy
No. Z~,06. ...... Date ............. .~.t ....~r ......., 1073.
THIS CERTIFIES that the building located at . .~/Ii...'7~ .~o~ ....... Street
Map No .... XXX .... Block No.. ~ ..... Lot No.~'....~g8%..~g~o~.. ~,~, ......
conforms substantially to the Application for Building Permi~ heretofore flied in this office
dated .......... }igC.. ~2.., 19~3. pursuant to which Building Permit No.
dated ........... ~....2g.., 19.~., was issued, and conforms to all of the require-
'~'~nts o~ the applicable provisions of the law. The occupancy for which this certificate is
j-~'~"'~sued ts . .~i~a~e. on~. r~iiy .~wel~ ......................................
The certificate is issued to . ~e~ .&. P~'.. ~!~.~ ..... ~.r~ ............
(o~ner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .... ~¢~...~ .... ].97~...DY.
UNI)F. RWRITI.:RS CERTIFICATE No...~. ~.~.~00~ .... ~ .. ~7.~..1973 .................
IIOUSI.: N[JMI3ER... ~ ..... Street...~$~..~0~ ...................................
Building Inspector
FOE~I NO. 2
TOWN 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)
Ne 6428 Z
Permission is hereby granted to:
Tem~.e.~.t,...~.~.~.~...~,~..AZ.C......~re.~.e~..Eo~at:tis & Wife
..[~tg.....~ox..~9 ..................................... i .............
......... .~.o.~..?..~.~.L..~.,..Z..: ..............................
to .. ~tu~.le~..new...on*.. £~m~1.~.. ~we.l.L~.~. ...................................................................................
at premises located at ...... .~/.~....,~J,~..R~ ...................................................................................
............................................. $.e,~.t,......~J,o~ ....... ~,~.,~Y.,, ........................................................................
pursuant to application dated ..................... x~......22 ................. , 19~..., and approved by the
Building Inspector.
Fee $...b~.,,B.~ .........
ng ~nSPector ~
TO~N OF $OUTHOLD
Building Deportmen~
Town Clerks Office
$outhold, N. Yo 11971
APPUGATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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 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 sewe(age disposal--(S-9 farm 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 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
3. Copy of certificate of occupancy $1.00
$5,00
Date ...... J. ?..?.3 ....
New Building ....].c.~ ........... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ...~:./.~ ........ ~,;~...,~,gA~ ........ ~.~.~.....~.~.0~.....~.,.~ ..........................................
Owner Or ~ners Of Prope~y ...... ~.~..~,..gD.~.~.....~i.g.~fi'.~ ..................................................
Subdivision ................. ~. ..................................... Lot No. ~..~.. Block No ..... ~... H~o....Z.~.?
l~r 22 Tem~e~ Ho~
Permit No...~].J:~.~ ......Date Of Perm,t ................... ?~pl,cant .... , .....................................
Health Dept. Approval .... g.g.~...~.....~).'Z~ .............. Labor Dept, Approval ....... ]~'.~.~.* ...............................
Underwriters Approval .,.]~...].~.~.~gJ......(~.;q~...~..Planning Boa~d Approval ....... ~'.~..[~.e ........................
Request For Tempora~ Ce~ificate ........................................ Final Certificate .... ~.~ ............................
Fee Submitted $ ~.00
Construction on above described building and permit meets all applicable codes and regulations.
Sworn to before me this
Applicant ..~.~ ...~.~
........... ~... day of ......... C~c.~ohar......1.9~.~ ....
Notary Public .................................... County
(stamp or seal)