HomeMy WebLinkAbout8739-zTOWN OF SOUTtIOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at lit.0ko;t'X .&. ~.Q~tt.v.I~. AVe. Street
Map No. ~[ ........ Bloek No..~ ...... Lot No, . ~...S~}~q~...I~t~? .........
conforms substantially to the Application for B~lding Permit heretofore filed in this office
dated .............. ~lY...] ~9.. ~ p~suant to which Building Permit No.. ,~39~
dated ......... ~g~Y...~6 .... , 19. ~, was issued, and conforms to all of the requke-
ments of the applicable provisions of the law. The oecup~ey for which this certificate is
issued is .. P.~i~a}.i. g~r~gO..(..I¢~.~0~Y, hlqg) ................................
The certificate is issued to ..l~$a~ .~}.~$ ..... ~.~ ........................
(owner, lessee or ten~i)
of the aforesaid building.
Suffolk County Department of Health Approval .~ ~ ..............................
UNDERWRITERS CERTIFICATE No..I~.~.~ ......................................
HOUSE NUMBER .... 90.Q ...... Street ... ~ie~y ..............................
~0s720 Sold View Ave Southold
..... ......
Bu[lding~ Inspector ~
FO~ NO. 2
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 8739 Z
Permission is hereby granted to:
J~ d.~.,...~'.Lz...l.,t.,.z..a,..m. ~....AZq.. I~,..z. ~.& .z...a..~.L.~.?~.& ~.z..a..~?m ..
.................... ~..o.~.~.o.,~ .........................................
at premises located at ..... .~,g, ,t]~dv~,c?.t:f..,A, ye 8: ,,}.~.g,,~..qr~. ,~,~,o,o~ .................................
.......... Soutsho~. 4 i{.Y.
pursuant to appJication dated O'uly 16 "/6
........................................................ , 19 ........ , and approved by the
Building Inspector.
Fee $ 10:00
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
Southold, N. ¥. 11971
APPLICATION 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:
1. Final survey of property with accurate location of oll buildings, property lines, streets, and
unusual natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage dlsposol--(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, o 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.of property showing oil property lines, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings.
3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in-
formation required to prepare o 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
Date ......~...~..~....(...I...%.~......~. .........
New Building ..... .~. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land A ............
Location of Property .... ......
Owner Or Owners Of Property ..,~/m~z:~,L./~.. ........ ..,Ir~...~;~../~/~./..~.~3..Z ......................................................
Subdivision ................................................ , ............... Lot No ............. Block No ............. ~House No .............
Permit No. ~'.2.~...~... Date Of Permi ~. pplicant .. .~ ..............
Health Dept. Approval ............................................ Labor ~pt. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .....~.. ...................................
Fee Submitted $ .....~ .....................
Construction on above described building and pj~rmit m~.ets otl aL:~icable codes and regulations.
Applicont ..... q ............................................
Sworn to before me this
................ day of ............................................
(stamp or seal)
Notary Public .................................... County