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HomeMy WebLinkAbout8365-z FOI~M NO. 2 TOWH OF SO~TgOLD 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? 8365 Z Permission is hereby granted to: .~;~....~.O:L~ ................................................... '...~...~.&~..~.z~e~ ................. ~ .................... ........ ~e~..~o~.....~03 .................................. ~o.~ft...nx~..~c~,.~.~,.o.~...~....e.~f.t..~..C..~.~..~.~.z..t..~g ............................................................. at premises located at .]~/.~,:*~. ,~:.~*~ , . . ............. , .~ ........... ~ ................................................................. . . ........................................... ~, ..... : ....... :..,.J]~a~. el& ...... ~.;.~:, ............................................................. pp~uapt to application .... ~,:.....:~ ...... , 19~,_~.,. and app;ov.ed by t~e BUildinn Insnector. ~ ' , .... ?: FOEM NO. 6 TOWN OF SOUTHOLD , 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 Budding Inspector with the following; for new buildings or new use: l. Final survey of property with accurate location of all buildings, property lines, streets, aha unusual natural or topographic features. 2Final 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 s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), No~-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property hnes, streets, buildings an.d 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 ,t/./.~. Date ............................... ~././.~_.~ New Building .. Add, ion ... ~ Old or Pre existi Building iV~ nt Land Location Of ;';~;~;~ ii.~,,~~...~.:...,~-~~~iii:~.~'" .............. iiiii'.iiiiiiii Owner Or Owners Of Property G' L C to - R Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No...~..~.~....~-,~. Date Of Permit ............................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......... ~ ....................... Fee Submitted $ ~"- f described building and permi] me~ets/all app,l, icable codes and regulations. (stamp or seal) ~ ~c [1 {-~ ~K DE~IGN GR©I IP East 20 Street, NewYork, N.Y. 10003 telephone · I: 21 2 ) 4 ~ 5 - 7 9 3 0 ALL RIGHTS RESERVED ALC DRAWII~IOS~SPECIFICATIONS ANC) COPIES THEREOI~ FURNISHED BY THE ARCHITECT ARE AND 5HACL ~EMAIN HIS PROPERTY., deaw~n~l ~itle job number scale