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Home My WebLink About8984-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at .. i~/.S .~a~g~.~.ew..Boat1 ...... Street Map No....x~ ........ Block No...x.x. ..... Lot No. .. xx... ~.Q~t~ .~l...~ ~.~ ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~O.v...29, 19..~(~ pursuant to which Building Permit No.../]9~.~Z dated .............. ~o.v...~9~, 19.7.6., 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 . .P.r~ate. ~ne. £~.~:~..dweLling ...................................... The certificate is issued to . F.O~l.d~.~'~..H.c~z..I.10C ..... ~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~ep~..$2..~.9.?? .... by. ~,..¥~a... UNDERWRITERS CERTIFICATE No...N~7~0 ..... Ju~.~ ............. HOUSE NUMBER ...... 97~.~...: Street ... ~ .~.$~.w..~.o~..d. ......... .~.o.u..t .h.o.l.d. ..... ......... Building Inspector ~ FORM[ NO. 2 TOWN OF BUILDING DEPARTMENT TOWN CLERK'S SOUTH'OLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8984 Z Date ............................... ~O~' .......... 29"" 19"'~6' Permission is hereby granted to: ....... ,~,~.b~.l.,~l ............................. to ~.t~;I,d...t~m¢, Q~a .tt. at~ll,~: .rl,.¢e.].li~, ..................................................................................... located at ....;N/~...]~,.V~e~r...~. ................................................................................ premises ................................................ Seu¢.h o.q.ct..... ~. ~.~2. ~ ........................................ pursuant to cpplicotion dated ............................. }/0.~. ....... ~.9 ....... , 19...~/~, and approved by the Building Inspector. Fee $...3.0. * ~).~ ......... Building Inspector TOWN OF $OUTHOLD , Building Depa~tment ¥own Clerks Office Sou~hold, H. ¥. 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, o 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 end 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 $1.00 ....... New B~ilding ....~...... ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... ,.,.1,.~....~./~./.~...~.~).~.~.$.~ .~... .................... ,.4.~....~.~. ...................... ~.. ......... Owner Or Owners Of Property ....~..°....~.....~...~.~..~..~......~..[.e'...~....~'....~....~.!.V'....C;...: .................................................... Subdivision .................... ............. BIoc No ............. Ha se Permit No...~.~.~...~...'~. Date Of Permit/~..°~/.~',~Applicant .i~.~'..~'~..~.-..~..~....~..,,~,,~?,~,,/, ,~,,,~.~,.~. ........ Health Dept. Approval ~,~..~..~.,..~.~....|..~..-J..~l. ......... Labor Dept. Approval ................................................ Underwriters Approval ,..~..,.,'.'~,: ....... ~ .............. : ....... Planning Board Approval ........................................ Request For Temporory Certificate ........................................ Fin~.l Certificate ........................................ Fee Submitted $.....~..'. .......................... Construction on above described building~7~r~t,:e:s a~p_ :abl,e code,~ and regulations. Applicant. ~~'t'X~....~...... ~..: .: .......................... Sworn to before me this -- ..~.::~,/~ da'..~bli; .,.°f ....~..:,.,.~ ...Z.....~.~ou.~..~( ' .... (stampor ,~X~k~~1 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: 1. Fina~ survey of property with accurate ~ocation of a~l 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 equa0. 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peopert¥ showing a~l property lines, streets, buildings and unusua~ 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land 3. Copy of certificate of occupancy $1.00 use $5.00 Date .. 4/.~,4/.~(~ ................. New Building ............. Old or Pre-existing Building ...x ........ Vacant Land ............. Location of Property . .9..7.~.5..~..~.~.~..3.a.~?.~.e?..~..o.a.~. ,..S.o.~.~o.~.~. ,..~e.w, .~o.~.~. ....................... House No. Street Hem/et Owner or Owners of Property .~h~ .~]qz;t;h .~,,qz;~ .Bank ,~ .Trust .Co ............................. County Tax Map No. 1000 Section . .~ ........... Block ...1 ........... Lot..lz~..At, ID ....... 1000 88 3 22.1 Subdivision ................................. Map No ............... Lot No ............... Permit No..7.8.9.z~ .~... Date of Permit .......... Applicant .w.~.c.~.~,a.~., .w,~.c.~.ha.~ .~..~.~.e.~3,~, .~, .¢. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ., .~; ................... Fee Submitted $ .~.-.qq ........................ Construction on above described building and permit m.eets all applicable codes and regulations. Applicant ....... ~~..~.. ,.. ,~z..~~ ................. Trrt.~ A~ I~TAIdP