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HomeMy WebLinkAbout9008-z TOW~ O~,$OuTnO~D BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9008 Z Date .......................... Deoe~l~......l~l,., 19.....~6 Permission is hereby granted to: Tho~...W.e.r~.. ~.~$.....AZ.g...~.;~t~...Wr~.ght~.. ~ wife ............ B~x...~.7.....Aq~b~g~e ........................... to ..b. Ulld..~.~¢...on,~..f~mll¥...d~e&li,ng ................................................................................... at premises located at .~,o.t,..~&..~..~.~l~.~ie~..g~ ..................................................................... ........................................ 8/,8...C tts ~.~ zr.. ~.v.e ......... ~ou.l~he.3,d. ......................................................... pursuant to application dated .......................... ~..fL0......1.~. ............ , 19..~.~., and approved by the Building Inspector. Fee $¢~.~..~ .~..l~. ............ Building Inspector \ ' FORM ~qO. 6 TOWH OF SOUTHOLD , Building Department Tow~ Clerks Office Southold, H. 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, unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposals(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 ~tatement 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 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 BHilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Lend .............. Location Of Property ....... ..~..?...O.. ...... .2G~,.~..J~.~..~.. ...... ~1~.~..~.. ................. ~,D...~w.~'.LR.I.~ .............................. Owner Or Owners Of Property .....~....~..!~...~'..........~'....~.~.(~.~. .......... .(~...~...I.~./L..~. .............................................. Subdivision ...'~.J~d.Cb.V.l.~.~. ...... ,~7.~9~.).,.~. .................... Let No. ~...~...~ ..... Block No ............. House No...~:...~...0... Permit No..~..~.~).o~..~.... Date Of Permit ./~/~.~..~.~.,Applicant .,~,~.~A~.,~:~......~...~J~, .~.Z~,.~,(~,,~.t ............ Health Dept. Approval ~/~t/7.~ ....... ~..'..~..O...'.~.~.~,.Lebor Dept. Approval ......... ..~....~'... .............................. Underwriters Approval .~.~..[e.3..~..~. ........................... Planning Board Approval ........ ~ .......................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .......~ ........................... described buiJdlng an permit meet oil applic hie cod~ and regulations. Applicant .......................................... Sworn to before me ~,his ...... ............. Notary Public -.~.~r~/...~, County (stamp or '",:'~THE NEW YORK BOARD OF FIR~'i:,0 '"'?-I:?' ;[ ; :} !:J C~RT F ES THAT Ralph ~r~ght, w/side of Custer Ave., Southold L. Joseph -D. :Mazzoni, 227 Waver!y Ave. Medford, L.I. 1!763 : -":.,' Li¢,i482 D This certifi¢ote must not be cJtered in any manner; return to the office of the Board if incoFrect. Inspectors may be identified