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HomeMy WebLinkAbout7462-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6~19 ...... Date ............. June...~.$ ..... ,19.7~. THIS CERTIFIES that the building located at .. S~er~kitlg' Road .......... Street Map No. 'l~ass'; 'Fm~ Block No ........... Lot No.. 13~ ... ~utehogue. · .I~ ,E.o ....... conforms substantially to the Application for Building permit heretofore filed in this office dated ............. July "30 19..7L~ pursuant to which Building Permit No. dated ............ AUK" '7 .... , 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . 'Px'ivate(~cces'so~'y')' 'swimm~ng .pc~l ................................ The certificate is issued to Ch~rl~'$ ..C:. '~4~tt'~ ....... @~rner ....................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . E oi~, .............................. UNDERWRITERS CERTIFICATE No .... ~. 20~+~27 ..... Ja.n. · ~.3. · · ~9.7.~ ........... HOUSE NUMBER ..... ~0 ....... Street... ~;ez, l.~r,g i~oa<l ....................... Building Inspector FOF~I TOWN O~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 7~62 Z Permission is hereby granted to: ...c.~ ~.. >:,!~.~ .t..~......~. ............................................ .............. Cu.~c~co~ue ............................................. , ....e...t... J.9...q ..~..t.....z..*.~.). ................................................................................... ........................................ at premises located at .~..~.,]~O.~...1.~O.....~i'~.~..;~-Z?~....*i- ......................................................... ....................................... .s...t..e.~.z....~.,~..~,a.. .............. ~..t..e..h...o.~-e- ...................................................... pursuant to application dated ......................A,.~..~ ....... ~. ............ ',....., 1~..~......, and approved by the Bu,ldh~: nspector. Fee $.,.~.~. ?....0~... .......... ......... : .... TOW..N OF ~IO~THOLD Town Clerks:Office Southold, N. Y. 11971 AP 'LICATION FOr 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 Ioca~ion 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 Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from th~ 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 1¢257), Non-conforming ases, 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, 6ccupancy and condition of buildings, 3. Date of any housing code or safety inspection of buildirlgs 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 $5.00 3. Copy of certificate of occupancy $1.00 ~ew BuHdin~ ................ Addition ................ Old or Pre-ex[stin~ Buildino ................ VocOnt Lond ..... ......... Owner Or Owners Of Property ~ H ~ ~ ~ Subdivision .......... (~..~}..~.~.~ ........... E.~.}~.~..Lot No .......... :... Bbc~ No ............. Hous~ No ............. Permit No. ~ ~ b ~ ~te ~ ~ .................... Of Permit .................... Applicant ...i .............................................................. ~eolth Dopt. Approvol ............... ~ .... ~ ............ kobor Dept. Approvol UDd~F~Fit~FS ADDFOV~I .............................................. PI~DDiDD BO~F~ ADDFOVDI ................... ~.~. ............... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ........... ~ ...................... Construction on above described building and permit ~eets ~1 applicable cad, and regulations. Sworn to before me this ................ day~ .................. Notary Public/..~ .............~nty (stamp or seal)