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Home My WebLink About9010-z FORM NO. 2 TOWN OF SOUTHOLD 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? 9010 Z Permission is hereby granted to: Building Inspector. F~ $..~..V. ............... Building Inspector FO~ NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Soufhold, N. Y. 11971 APPUGATION 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: I. 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 fram Board of Fire Underwriters~ 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance fram 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 end "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, r 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 Building ..~.i ........Addition ................ Old or Pre-existing Building ................ ~Vacant Land .............. Owner Or Owners Of Property- .~.~....~.~..~7/ Subdivision ...................................................... Lot NO ,o'~-J ~.e~*.. B ack NO ............ House No ............. Date~/,_~_Of Permit .~.~',~a~.....~..~.~..~... .............. Permit No. Health Dept. Approval ..~.../..~'/...'?..~... ....................... Labor Dept. Approval ................................................ Underwriters Approval ..~Z'.~//~.~',~.~.. .......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .....~ ......................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicab~e~codes and regulations. Swan to/before met~ ~ ~_~z//~/~/~/ · ..q>/~'/~. day of ...~.~ .................. (stamp or ~ ~ ~ NOTAR~ PU~Lt~, State ol New Y0r~ OWNER: TI~-[ j ] .LENDING INSTITUTION L~S1ED HEREON, AND · O THE ASSigNEES OF THE LENDING INSTI' AT , ~D~ VAN TUYL, P.C. - '- :SUFF. CO, DEPT. OF HEaLtH SJ-RYI(~ , ' STATEMENT OF I~NT . DEN~ WILL CONFORM TO THE m O~ H~LTH. LOT 71 ,-:' , ' , ~ , , ; ~t ~; '. ,..~ , . ~ ~ ~.~'~ L -T APPROVED~ AS NOTED FEE: ?y~ BY ~ NOTIFY BUILDING DEPARTMENT 765-2660 9AM TO 4PM FOR BEQ'd~P,- ED INSPECTIONS: 1. BEFORE BACKFILLING F~U~DA- j TION OR START FRAMING 2~ BEFORE COVERING DIPI:LINE 3~ FINAL WHEN JOB COMPLETED '1 '? ,I :1 APPROVED A,S NOiED NOTIFy BUILDING DEPARTMENT , 1. BEFORE BACKFILLING FCUNDA- TION OR START FRA~'ING 3. FINAL WHEN JOB COMFLETE~ 1' 4-+4 I