HomeMy WebLinkAbout8842-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certi[icate O[ Occupancy
No... Z.9058 .... Date . · June. · .12 .......... , 19.
THIS CERTIFIES that the building located at ./45. Landing Road ...... Street
Map No.. 156 .... Block No. ~. Lot No ..... 2.~.~ A ......................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . July. 6 , 19. ?1~ pursuant to which Building Permit No... 88/*2Z
dated Sept;ember.. ~ ..... , 1976 , 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. ~, .Deck .addit;ion to ~ .Private 0tie F-rally.Dwelling .............
The certificate is issued to . James & .Rosemary. Trent-1 a~ga .................
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval N/It ..........
UNDERWRITERS CERTIFICATE No ................ .I~I/R. .......................
HOUSE NUMBER /~5 .... Street ...... Landing .Road .......... '. .........
Building Inspector
~'0~1~ NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N. Y.
BUILDING PERMIT
~HIS PERMIT, MUST BE KEPT O~q.,,,THE PREMISES UNTIL FULL
COMPLETION ~J~'~E WORK ^UTHO~RIZED)
N? 88~2 Z
F'ermission is hereby granted to:
..... J~..&.~o~e~ar~...~ren~ala~e ...........
............ ~Ud ~ua..i~d .......... .~.t.~.k .o.~e ............
~,~-~:~ .................................. ::.~.'::~ ..... : ...................................................................................... ,~ ......................
~.:-~.~ _~.~'-~'~f' ~t p;emi~ses Iocoted' et ..~...~,..J~.~.3.~.. ......... ..~.~.~1.1~.~..~..~.~.;~.~ ................................................................
~...~; ~ ...... : ......................... : ......... ~,,,,d~..~O,~ .......... ~,~o~,e ............................. : ..........................
~', ~:~ - .......................................... , ..... ? ............................................. ~, ..................................................................
~]pursUant to apphcahon dated ...........................~.~..~. ................... , 19...~, and approved by the
B:uildmg Inspector
Building lnspe, E~o,~ ~ [
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
$outhold, N, Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OP, ink, and submitted in DUPLICATE to the Building
Inspector with the following; for new buildmgs or new use:
1. Fmal survey of property with accurate location of all buildmgs, praperty hnes, streets, ana
unusual natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage dlsposal--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and s~milar buildings and
installations, a certificate of Code compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (pr.or to April 1957), Non-confarming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property hnes, streets, buildmgs and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildmgs.
3 Date of any housmg code or safety inspection of buildings or premises, or other pertinent
formation required to prepare a certificate
C. Fees: I. Certificate of occupancy $§.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00 tk~--~A ,)
Dote ............... ..~...~..~...~ ) ~ .................
New Bqilding ................ Addition .....~ ......Old ~r Pre-existing Building .........,~... Vacant Land ..............
.....
Location Of Property ......... ~,.,.~.~J ~,.~ ....................
....... ........ ......... ..........
Subdivision?~%..~ .-~..~ .i...~ ~iii~i].~..~.~..~ .~... ~L~o"~.~' J'~' ' ' ............ ~~~'~BI°ck No ...... : ...... House No ..........
Permit No .... ate Of Permit ............ Applicant ...........................................
Health Dept. Approval ............................................ Labor Dept. A, oproval ...............................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For '1'emporary _Ce. rtificate .................................... ./~ 'F'~a.I Certificate ......... .~. .........................
Fee Submitted $ ......~.....~.. ............... /~,~ // ''
Construction on above describ~p:~i~:n~.~ ~~.~.'.~i.;.~i ........ ~'~0
Sworn ,o before me tl~ ~' ~J~ '7~'"m9'~-- -~"" If
Not ~ u 'c .... L~~ .... ~o. P.bh., S,.,. o,~.. /~_ ~ /.)1