HomeMy WebLinkAbout7455-z FORNI NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISE
COMPLETION OF THE WORK AUTHORIZED)
7455 Z Date .............
UNTIL FULL
Permission is hereby granted to: :
Sk$.:.~..~...k;Z.p...~.9.9.!~....~.~m.~./.q...~.a.~t...§~.~.ea & wt~e
......... 250...~x..J~a~ ........................ i .................r
Cuteho~
to .~bL~i~1~..~..~p~.i.Ya~..`~m~L1~&~.p.~...~&th~en~..~..a~eas.~3:~.s[ .......................
ot premises Iocoted at .~...~..3~......~.a..~.~..~a~g ......... i .........................................................
.......................................... ~.e~m~.t.t..~,~ ............ '..&~.ut~l~ ........... ; ...........................................
pursuant to application dated ............................... ~J~.....~.....i....., i9~.~.,;., and approved by the
Building Inspector. ~
NOTi~ ~ader~riters certifieat~ :requi~e~ fer c/o
FORM NO. 6
TOWN OF $OUTHOLD
, Building Deportment i
Town Clerks Office
$outhold, N. Y. 11971
APPLICATION FOR CERTIFICATE oF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and sbbmitted in DUPLICATE to the Building
Inspector with the following; for new buildings or new rise:
1. Final survey of property with accurate location of all bui dings, 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 Uhderwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance from rife Architect or Engineer responsible for
the building.
.5. Submit Planning Board approval of completed site plar~ 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, bccupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildihgs or premises, or other pertinent in-
formation required to prepare a certificate.
C. Fees:
l. 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 .,~..~ ~ ,/~**.~F~..../.,I.~ .[.,~ .7~
New B~lilding ................ Addition ................ Old or Pre-existing B'~ilding ................ Vacant Land ..............
Location Of Property .~).~..~.~ ..L~.~.~.I~..[~.....~.O..6<.T./.~.~.~.......I~O.~.~I,...[.L~.~.r).i ............................
Owner Or Owners Of Property ............................................. . .......................... ...(~ ................................
Subdivision . .~.~.[I~.V.J.~...IA)......0,..~....~....~..~..~.~...J. ...... Lot No...~..~.... Block No. House No .............
Permit No..g.,c/.~,~,.~,~r... Date Of Permit .................... Applicant ..................................................................
Health Dept. Approval ............................................ Lobar Dept. Approval ................................................
Underwriters Approval ..]~'..J..~...)~...~..~..~ .................... Planning BOard Approval ........................................
Request For Temporary Certificate ........................................ Fin~ Certificate ...... ~ .............................
Fee Cubmit~ed ¢ ~. 0 0
Construction on above described building and permit meets all applicable codes and regulations.
(stomp
or
Sworn to before me this
.... ..L( ....... day ......
Notar~Public ....~...C.;-~..~..'~.~..~;....~..... County
ANTHONY AB/~TE
Notary Pubhc, State of~ New York
No. b2-0000850
Qualif,ed in Su/iolk'Counb/ ?~
("omrmss~)n Expires Ma!ch 30 ] 9
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