HomeMy WebLinkAbout8835-zTOWN OF SOUTHOLD
BUILDING DEPARTM~,NT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
...... r ate .......... "*':":...79 ........
THIS CERTIFIES that the building located at R,0,Ig, BlS Pee, B.a~., Blvd
....................... Street
Map No...x:X ......... Block No....xkr. .... Lot No, .~... ~..X~.0~,,..~.Y.,. ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... l~.el~.~.. ~.., 19 ~.6.. pursuant to which Building Pemit No.. ,8.8~ .~..
dated ........ .8???....2, 19.7.6.., was issued, and confoms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ?r..i,va, t.e,, .o.n.e...f, .a~.i!.y..~.w. 9,1.1.in.g .~..i.t.h..an..a.d.~.i.t.i.o.n ..................
The certificate is issued to J.a~..o..Kq, .o~..i.e.s ..&...M~.r..y.1..y~..G.r..o.f.f, .....................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .N,.R,. ............................
UNDERWRITERS CERTIFICATE No..10.e.n.~..~..g ....................................
HOUSE NUMBER ...1~2~. .... Street .P..~...Rd...~.]...l~.e..~?.o.b..~.~...D.~ ..... .L~.~.0~..
Building Inspector
]FO~ NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFICE
SOUTH'OLD, N. Y.
BUILDING PER~IT
('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED')
8835 Z
Permission is hereby granted to:
~..~.?....~...,.~.....~.c......~....~..~..~s.t..t..
.................. ~;.~.~,~.~k ........................................
B,~ild a~ addition oz~ exis%ing
tO .......................................................................................... ; ......................................... ,: .....................
o~ p~em~s.~ l~:ot~ ot ...~.;..O..;.~.,. ..... .~/~...~..e.~,o....~..~,..~'...~!..~........(.~.-,..~.~...,~,), ....................
...............................................................................
pursuant to application dated ............................1~..~..~....:..~.. .............
Building Inspector.
FORM NO. $
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
$outbold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This apphcation 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 buddings, property lines, streets, and
unusual natural or topographic features.
2 Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal).
3. Approval of electrical installation from Board of F~re Underwriters
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
mstallatlons, a certificate of Code comphance 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 buildings (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 buildings ar 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
D te ....
New Building ................ Addition ....~. .......... Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ..~..~.~.....(r~... ......... .-~'..~. ....... ..~.~.C'.~..~..*.':.:~.c~..~..~.~../~..~.~.~.~.r./..~..~.~..~z~. ......
Owner Or Owners Of Property .J~..~...~. ..... ~...~...~.,~:.L.4~.~ ...... ~. ..... .../~.....Q....~...~..~..~..~ ....... .~..&¢,..¢./..~'.../.~. ....
Subdiwsion ................................................................ Lot No ............ Block No ............. House No ...........
Permit No. ~...~...~..~..~.. Date Of Permit ./~../.~...'~/....Applicant ....... f,~,~...Z/.~....~...~.....~.....~....~w..,_ .............
Underwriters Approval ..,.~.~.~ .................. Planning Board Approval ....... ~,.?...(,.,.d~T.,. ...................
Request For Temporary Certificate ........................................ Fin~ Certificate
Fee Submitted $ ....................................
C onstru ct ion on above describ~ ~p ,~in .~...a.~ d.~. p.~.~.m, i~..~.m~., i.i~..~Z~Z~ ,..~ Z .~i...~ .~ .~.. r..~ .~ .~,..~i,..~ .~i: ..........
Sworn to before me this -- / /
( UNDERWATE-R
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