HomeMy WebLinkAbout6479-z FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, FIr. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 6~79 Z
Date .......... /....:....v ................................... ,
Permission is hereby granted to: ,
,,
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~o ....~.~...~.~.~. ........ ~I...L.T...~..c L.:..~ ........ .C..:...~..! !....L ,..~.:.:. ...... ~..:::.......::...~.,.>...:.......:~.(~,.! u ~.
at premises' located at ..... N ~ :' '
........... ,~.,~,~. ......... ,o. ....... £~.~....f... ...... ~.~ .................................
....................................................... 5.~...:.....T..5.. o. .~....:1~ ......................................................................
pursuant to application dated .................. ,/~.:~.~......!...~,. ............ ~ 19...~-.~, and approved by the
Building Inspector.
BUilding Inspector
TOWN OF $OUTHOLD
Building Delm~tment
Town Clerks Office
$outhold, 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 ~uildings, property lines, streets, and
unusual natural or topographic features.
2. Final approval of Health Dept. af water supply and sewerage disposal--(S-9 farm or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. CommerCial buildings, Industrial buildings, Multiple R~sidences and similar buildings and
~- ~installatians, a certificate of Code compliance fram 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 Uses, 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, oi: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 pre-existing dwelling or land use'
3. Copy of certificate of occupancy $1.00
$5.00
Date .......~..~...... · ~. ,~...~..~-...
New Building ........... Old or Pre-existing Building ................ J ........... Vacant Land ............................
...... .......
Location Of Property ................. .... ....
Owner Or Owners Of Property .....~..~....~../~. ............. '"~ ..~..~.~-.~..~.~.(.Ll'l....~.......t~....,.: .~.~..~.,~,,.,~'.,
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Health Dept. Approval ............ ..~,...'.....~... ................. Labor Dept. ,~pproval ...............~.......~.. .......................
Underwriters Approval ...~,..,,-..~..,~...~,,..~,.,~.,~,....~.,..~,,~.Planning Boa;rd Approval ........ ~1.,~..: ..................
Request For Temporary Ce~ificate ........................................ Final Certificate .......~ ...............................
Fee Submitted $ ,~ ..............................
.......... ~.. d.y of ~ [ ¢ 7 ~ (stamp or seal) ~ ~ ~'~ `~
.................................... co..,, 7