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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. ,'1 ~L^~ Fo~ CPZ~ J 4:24 C24- ~,L I' I ~L ~,'- I" bi ~Lu % L E VAT/0 kJ / / , PL*,,, Fo,=,, ' i