HomeMy WebLinkAbout8738-z FO~NI NO. ~
TOW~ OF $O~TSOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 8738 Z
Date ...................... ~.t~. ....... .!.6 ............. 19...26
Permission is hereby granted to:
Roger M~nz
~9~ ~+~. J.~me.~Dor.$ .
~ d ~' d
to. ~j~,..~..~.~.~...~e...,~.~mli~.... ~ ~g ....................................................................................
at premises located at ~o~..].~ .......... .~.~p.O~,.~.~ .......................................
...................................................... b~.~Z:~.o.~..~.~y.~ .............. ~ .......................................
pursuant to application dated .................. g~.~ ........ ~.~ ................ , 19..~.., and approved by the
Building Inspector.
Fee .......
~'OWN OF
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 triplicate 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, 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 aT 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.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
$5.00
Date ......... "~,,,~',,J..~ .............. Zf .J..~..Z2
New Building ......... Old or Pre-existing Building ............................ Vacant Land ............................
Laeat,on Of property
Owner Or Owners Of Property .,.-.,.~(~£..//'.....A.:....c:~,.....~..--.~.~.-~.~....~.,../.~/.~/~,/b)..~ ............................
Subdivision ..~,..~./~,~/J~...,,~', ,~.i/~..t~. ............. Lot No ...../J..... Block No ............. House No .............
Permit No. ~.~..~,,~,,., ,~,,. Dote Of Permit .7~/~,/~/~,~.,,..,AppJica~i~./~.,,....,~.,.;....,,~,,,/~,,~;.';,~ .....
Health Dep.t Approval .~./.!~,7. 27. ............................. Labor Dep.t Approval ......................... . ~ ~ , ....................
Underwriters Approval .,~L,,~./~.~, ........................... Planning Board Approval ...~.~. ......................
Request For Tempor~ary Certificate ........................................ Final~Certif/ifate ..........................................
Fee Submitted $ ..~...~..~....0.. ....................
Construction on above described~~s--~l' a~ob~ ._ :s~
Sworn to before me th_is
........... ¢. ............... , ...................... v .~:~ ,- .
The water suRlY & seWaP dIN~e~l sys-
toms for this residence wili conform to the
slllldards of the Sulfo~,
ment of Health Se~vtce~,/' ////
¢0~ II
c¢
SURVEY FOR
ROGER MUNZ
AT LAUREL
TOWN OF $OUTHOLD
SUFFOLK COUNTY~ N.Y.
SCALE~ I"= 50'
JULY 9, 1976
I~na~thorlzed alteration or addition to this sun, ey $ a voalion al
~cti~ 7209 of thenew Yo~k timte Education Low.
Copl~ of this sun~e~ map not bearing the land .susveyor's inked
s~al ~r embossed leBI shall not be considered Io be o vel;d copy.
, ~uar *~tee, s or c :d..['~:ofion$ indicated hereon shall run only to the
p!mse fo~ *ham th~ sur~ey j* pm[oared, and on his behalf to the
-, tJ~e ~ ~mpapy, governmental agency and lending institution listed
· h~rec i' and?o the a~signons ~f the lending institution. Guarantee~
at ~tif!cafions are not transferable to additional institutions afl
sObse uent owners.
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