HomeMy WebLinkAbout8382-z FOENI NO. 2
TOWN O~ $OUT~O£~
BUILDING DEPARTMENT
TOWN GLERK'S OFFIGE
SOUTI'IOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 8382 Z
Permission is hereby granted to:
.J~,ama..~ ~,,,?,ey.. & ..*,r~e~. ..............................
.......... ~aelc..ava ......... Pa~L~lmt~e ..............
to .1~t~. ~a~.. qe~e as at~r...s ~o~..~t XaJ.~ ...................................................................
at premises located at ..... ~j~OJl~.~*~,..~t~t ...... ]J~,tJJJkl~..~la~ ......................... ; .............................
...................................................... ~/.8..:~z~eX../~e ......... ¢'atelaejae ............................................
pursuont to opplicotion doted ....................... ~..~ .....~ ............. , 1~::~, an~ a, ppr.oyed by the
Building Inspector.
Fee $..1.0 ~,~ ....... ,.. "
Building InspeCtor . J
FORM NO. $
TOWH OF SO~THOLD
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
instructions
A. This apphcation must be filled m 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 w~th 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 installahon from Board of Fire Underwnters.
4. Commercial buildings, Industrial buildings, Multiple Residences and s~milar buildings and
installations, a certificate of Code comphance 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-ex~sting"
land uses:
1. Accurate survey of property showing alt 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 dwelhng or land use $5.00
3. Copy of certificate of occupancy $1.00
Rte ............ ...............
New B~ilding ................ Addition ................ Old or Pre-existing Building ....t~,~ ........ Vacant Land ..............
Locat,on Of Property ~.7..~..~..¢_/..~.. ~....' c~ L/~,,,,, sm', ~ ~ ~, ~ ,~
..................................................... -.....; .............. : ......... ........................................
Owner Or Owners Of Property .~ .~.-.¢~.~.~..~.....~ ...... .r...~....~...~.~.r.~.~..~.......~..~..~..~.:..~,~, ......................................
Subdivision ................................................................ Lot No ............. Block No ............. House No ............
Permit No .~.~ '~'~-2 Date Of Permit .~../.~.~/.,q.(e:....Applicant ..;..~...E..~/.o.Z.~.~......~..C~9...~.'.q':.~,, ......................
Health Dept. Approval ......... .~....~...~... ...................... Labor Dept. Approval ....... ..~....~..~.......'. .....................
Underwriters Approval ............. .~/...~.....~.... .................... Planning Board Approval .... ..~....!.."~... ........................
Request For Temporary Certificate ........................................ Fined Certificate ......... .~... ......................
Fee Submitted $ .... ~.~ .................
Construction on above described building and j~er~nit meets all appl~le~i~s/'and regulations.
Sworn to before me this ~ /',/ ~00/
........ ~ day of ...../~ ~/'//', ~~'C'c~' ..... /.,~..... (stamp or seal]~nt- / / ~-
I_ ot-
_!0257