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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 J zo 0 .,c .0~<0