HomeMy WebLinkAbout7453-z I~OP,,M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIbFULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7~53 Z
Date ............. ' ........................................... ,
Permission is hereby granted to:
..~:~.~...w..~.~.~ ....... t/.~...~.'. ~..... Z.~G: .............
....... ..~./..~.......~!.C~.aff.~ ....... A~.?.L.f?..~.~/.
at premises located at .........................................................................................
............. '- O .
/~o7 fl . ~ ...................... ~ .........................................................
19,./..,~..., and approved by the
pursuant to application dated ..................................... ....
Building Inspector.
,...!..5. ..............
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Southold, 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 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 Un~derwriters.
4. Commercial buildings~ Industrial buildings, Multiple R~sidences 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 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, qccupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent
formation required to prepare o 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
Dote ... ~ ....................
New Building ................ Addition ....~ ........ Old or ~re-existin~ Bujldin0 ................ Vocont Lond ..............
Location Of Property ..M.~..~O.~...~ .......... .~.O~m.~.~ .............................
Owner Or Owners Of Property ..~..~.~ ....... ~~ ..............................................
Sabdivision ................................................................ Lot No../.~.0... Block No ............. House No .............
Permit No..~..~.. Date Of Permit. .J. .Applicant .~t'~J.b...~...~.~.Z ~ ' ............
Hea~th Dept. Approval ...~.1~ ................................. Labor Dept. Approval .... .~l~ .....................................
Underwriters Approval ....~1~ ................................... Planning B~rd Approval ..~1~ ...............................
Request For Temporary Certificate ........................................ Final Certificate .......~&~ ...........................
Fee Submitted $ ....... .~.~.~ ..................
Construction on above described building and pec~it meets all applicable codes and regulations.
.... ..........
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