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HomeMy WebLinkAbout8823-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No ............. Date ...................... , .... THIS CERTIFIES that the building located at~-~'~ ~W'¥ ~ab E7 S~ree% ~ap No .......... Block No .......... Lo~ No confor~ substan%~a]ly ~o %he Appl~ca%~on for B~ld~n~ Perm~ heretofore f~ed in ~s o~ee dated . . . ~C: ~.. ~.(, 10 3 ~ p~suant to which Building Permit No. dated ...................... ~as issued, ~d confo~s ~o ~1 of ~e requ~ men%s of the applicable pro~s~ons of the law. The oceupane~ for ~hieh ~is certificate The certificate is issued to of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. ~4 0 ~4 ff HOUSENUMBER ~0~_~ Street C{)U~47 ~' 7V C A ~ ~ ~ ................................................. ....... ...... ~ ~. ~/...~/: ~X f ...... B~lding I~spector FORM NO. 2 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8823 Z Dote ......................... Permission is hereby granted to: ...... ~e~3~s...3~e~,~ ...................................... ............... l~o~.~;h..]~ad ......... ~enpo~.~;. ........ ~pu.rsuant to application doted ......................... J~l~ ......... 20 ......... , 19.~.~.., ond approved by~t~he Building Inspector. Fee $.-.-~.~[*,g,a ....... 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 ~n typewriter OR ink, cnd submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. Final survey of property w,th accurate location of all buddings, 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 bu,ld~ngs, Multiple Residences 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 s~te plan requirements where applicable. B. For existing buddings (prior to April 1957), Non-conforming uses, or buildings and 'pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of braidings or premises, or other pertinent 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 Date r~/~.~..~.~...?........~..,, ..../...~...~....~... New Building ................ Addition ...,..~.. ........ Old or Pre-existing Building ' Vacant Land .............. Location Of Property ...~...~....~?..~....~........~.~'.-./~.'.~.x~......~....~...~.....~....?.. ......... ..~..~....~..~....~.~...~..._~.....7'. ...................... Owner Or Owners Of Property ..... ../~.../..~...~...~....~...~. ...... ~..~.....~..~. ~..Z...~..~ .......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No....~.~..~....~.06~' Permit No .~..,~.,.~....~,.,¥...,. Date Of Permit ......... .,7.(...Applicant .,../~'./~'A/~.~.~. ..... ~....,..'.~../~....~..~....Y...~. ......... Health Dept. Approval ............ ~,...~,. ....................... Labor Dept. Approval ......... ..~....~. .............................. Underwriters Approval ...../~,..~........~.,~.~.,..c?,..~../.~.,..~,.~'. ..... Planning Board Approval ....... ../~....~, ......................... Request For Temporary Certificate ........................................ Fmcd Certificate .........~ ............................ Fee Submitted $ ....~.,..~..~.. ...................... Construction on above described building and permit meets all applicable, codes and regulations. NotaT~uol,c~ ................................. County (stamp or s~l) ~ ~ /.~YL~ ~c~OCA5 B '{~Xe.L¥$- Avwe~oef> ! ,I'