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HomeMy WebLinkAbout6450-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No.Z~.~0 ....... Date ............A.~r$.l.....~ ..... , 19..~.. THIS CERTIFIES that the building located at ~. l~d. ~.~ ~..P~.t.~*~. ~ Street Map No ..... ~ ... Block No...X~ ..... Lot No. ~ .... 0.~,~..e.~$...E....~., ........... conforms substantially to the ApPlication for Building Permit heretofore filed in this office dated ...........~r...30..., 19.73. pursuant to which Building Permit No. ~.0~.. dated ............~.~.. 3.1..., 19..7.3, was issued, and conforms to 'all of the require- ments of the applicable provisions of the law. The occupancy, for which this certificate is i~.~s~ed is P~Xvate ~e family dwelling The certificate is issued to . ~.,.L.,. ~.t.r.a.c..h.a.n. .... ...0p~e...r. .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. ,~,. ................... ; ........... UNDERWRITERS CERTIFICATE No. N..lL~.~9. ..... J~'...1~...~.973..' ........... HOUSE NUMBER .2~0 ........ Street P.v.t. P~l .~. ~,... P. eter. a .~ec~ .8oad .... FOl~I NO. ~ TOWN OF SOOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'REMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Ne 6450 Date ...................................................... ..., 19 ........ Permission is hereby granted to: pursuant to application dated ....................................................... '., 19 ........ , and approved by the Building Inspector. Fee $...!....~.......2 .... Building Inspector TOWN OF $OUTHOLD Building Department Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF: OCCUPANCY Ensfructlons 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 U~derwriters. 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), Nomconforming ~ses, 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land :use $$.00 3. Copy of certificate of occupancy $1.00 Date . ~..~.:d.. ~.../..../...~. ~.~,.. Mew Building ................ AddiHo? .....~..2 ...... Oldgr Pre-existing BUikting ................ Yaeont kand .............. Location Of Property ...f,~,~.r~/"~"~'...).~.,~:z.:...Jj~.~....~....~~:~!~ .................................... Owner Or Owners Of Property ..../~j~r~4~.~..~,~..~.......~..~......~L~.~.~/ Subdivision ............................................ ~: ................... Lot No ......... ~....., Block No. g,~ ......... House N,,p ............. Permit No...~....?...~.i~... Date Of Permit ...~.~i.~..Applicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ,. ./.,.~.~,,,.:.~..~. ............. Plonnlng BoOrd Approval .................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $'-- Sworn to before me this ......... ~ day of ..... .~... .............................. Notary Public .................................... County (stamp or seal)