HomeMy WebLinkAbout6457-z FOP~I~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N,. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CC~MPLETION OF THE WORK AUTHORIZED)
N? 6457 Z
Permission is hereby granted to:
H~rhe~.t..l~tmc~. ..................................... ..............
......... ~Zd...O.~z,¢t..~ .....................................
.................. ]~.,...~r~on ...................................... ~
~e ..]~d..~r~.~dd~.2~r,..o~..e~.~t .~ng..~e.~-t..~n~. ....... i ......................................................
..................... .(&l~l~.l~o.9:.~..b~...~d..AP.Peala). ......................... ' ......................................................
at premises located at ........ $o.ta....61~6.~6..!:G~e~..s.i..i~.~..~s.t,~l.....Z.t ..............
............................................ .9.~..~...~.~..~...~ ............. E,..~nZ~ .......................... ~ ..................
pursuant to application dated ..................... ~..~, ....... ~.0. ............. ~., 19.,~., and approved by the
Building Inspector.
Fee $' "1~,~, ~O ..........
Building respect!
TOWN OF $OUTHOLD
Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OP~ 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 t~uildings, 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 Rebidences 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,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, o~:cupancy 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 prmexistin§ dweHin§ or and use:
3, Copy of certificate of occupancy $1.00 ;
$5.00
Date ............
New Building ...... ..~..~.¢. ....... Old or Pre-existing Building ..... ..,~...~.~:~.i ........... Vacant Land ............................
Location Of Property .............................................. '.~. ............................... .~ ..........................................
Owner Or Owners Of Property ./..¢~.~'.~.7' ¢/;...../~..~//.¢...~..~/ ~../~..¢.....~.~.~.~.'~.~T..~...~..:
Subdivision ~(FLc.,~..,,~Lc, E,,(~.~h,6~¢(/~J//.(:.~/~.Y....~.?.(~.~.(Jot No.~..¢.~(. Block No: ............ House No .............
Permit No.4..C;...~-~.....Z-..,. Date Of Permit .4./~,~l.4.~]~/.~.Z~Applicant ./. ,;(~'..~.~.~.~.,..~.~../..1¢..~.././.'.¢..E:..'.~,~ .................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .../~.../'.i~..Z.~.....~../../. ................ Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate
Fee Submitted $ .,.'..~.~,.~.~. .....................
Construction on above described building and permit meets oil appJjcable codes, and regulations.
..........
Sworn to before me this ~/~/
.¥.~-~ day of .~~.~-../..~....~....~?. (stamp or seal)
Notary Public .~/C~¢~.. County