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HomeMy WebLinkAbout8970-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .].64 .LT..L~ .T...0.L? .~.lf.~. ...... Street Map No.~A?Y,..~ Op ~S ~ , .... Block No .... ~ ...... Lot No.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~-~../.~., 19~. pursuant to which Building Permit No. ~.~ ~.(.~ dated . ......... ~ ~ /~ , 19V5 .... , was issued, and confoms to ~1 of ~e requ~ ments of the applicable provisions of the law. The occup~cy for which this certificate ..... **************************** ~e ce~i~,~a*.,s,~ue~ ~o ~-A~ ~+ ~ ............ ~ .............................. of ~he aforesaid building. Suffolk ~ounty Departmen~ of Health Approval ~ [~' ~w~,~ ~=~y~ ~o ..... ~:.~. .................... Building Inspector TOWN OF $~)UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8970 Z Permission is hereby granted to: .... .~.......s..~.~..~.!:..~.:.c ........ .~.~...r:.!.z...p ........ .... ,(~c... ~-~.:i..~.:!~ ....... ~.:~:.,'.~.c.~ ~ !Y~ kO..T ..... ~...~. ..8...4 ~ ..K!.~. .......... ~.~..~.~ .................................................. pursuant to application dated .......................... ,~ 0, ,~,.,....$,.~2,'i..., 19.,~,.~,., and approved by the Building Inspector. Fee $....L .................. Building Inspector '-" Lo+ 3 f TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 location 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 the 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 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, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings 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 Date ......i..~....~...,~...'.~Z .~::] .._~. ......... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... /..C!.-~i~. ;:~'!~..~.. ~ ~ *?..~...~.,.~" . ................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ..........~..j~.~ ............. ~..~.'../..'.~..~..i.~..~. .............. Lot No. ~..~. ....... Block NO ............. House No~..~.~. Permit No- *- ~.'?..Z~'.~ Dote Of Permit~.~? ................. Applica.t :~ Health Dept. Approval ................. ./..~.~...~ .......... i...Labor Dept. Approval Underwriters Approval ........................... ~.~.'.'.t ............ Planning Board ApprovoI Request For Temporary Certificate ........................................ Fin~ Certificate Fee Submitted $ ....... .~. ......................... Construction on above described building a~ permit meets all applicable codes end regulations. Applicant .... · '%~ '~J~V~ ................ : ............................................ Sworn tO b~efore~ me tt~s ....... '~ "~"~' day ~f','''' '~'''''r:'':: ...... ("?"~['.?. .......... (stamp or Notary Public C.~,~,7,~,~,' .. County