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HomeMy WebLinkAbout8326-zTOWN OF SOUTHOLD BUILDING DEPAIITMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ZT07~ ....... Date ............ Jnn~.. ~ ....... , lg. ?/6 THIS CERTIFIES that the building located at . .Cc~re~ .Creek. Road...(.$1 ~treet Map No. Koke.. 00A.. Block No. ~ ...... Lot No;~x.. Smtxthold ................. conforms substantially to the AppIication for Building Permit heretofore filed in this office dated ...... .8.~p1~ .2~., 19 ?~. pursuant to which Building Permit No. ~26~ dated .... ~)e.c.. .3 . ., 19 ?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P~';~.~.~O..aqCe.s.~or~r. ~tl~..n. g (ap. prove, d. by..P~d. Al~eal~ ) .......... The certificate is issued to tterbmrt. Lin~vmtt ..... Ownom ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .1~ ,R, ....................... UNDERWRITERS CERTIFICATE No. N,R, ..................................... HOUSE NUMBER ...62~ . . . Street ... C.~rey. Creek .Roa~.. (P.~t. Rd .~..12) Building Inspector · OKM NO. ~ TOWH OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE $OUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8326 Z Permission is hereby granted to: lll~ Lift.it FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ins~ructlons A. This application must be filled in typewriter OR ink, end 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 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 buildmngs (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of 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 inspechon of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: ]. Certificate of occupancy :$5,00 e B'll'ln ~ ' n I Date~'""?'"'""¥"?'"'?'"'~"?/// N w q' a' g ...............Addition ................ Old or Pre-existi g Bui ding ~ ..... Vacant Land .............. Location Of Property ...... ~....~~.......~..~...c~....c..~;.. ......... .(,~.K..~....~...J...~.J ....................... Owner Or Owne~ Of ~Property ../~¢~~ ...... .~,,~,~t..~.. .................................................. Subdivision ..... .~..~ ..~........~).,..~..t...~.. ......................... Lot No ..... .~.;;... Block _No....~. ....... House No...~.°...)".? Permit No.....?..~...~..~..~E)ate Of Permit ....~..,..c...~/.~.~plicant ..~...~...~~~ ..................... Health Dept. Approval ...... .~.......~ ........................... Labor Dept. Approval ....... .~...;.~..~ ............................. Underwriters Approval ....... .~....~...~.. .......................... Planning Board Approval ..... ..J~....!.~.. ......................... Request For Temporary Certificate ........................................ Fincd Certificate ~ ' Fee Submitted $ ...~....~ ..................... Construction on above described building and permit meets all applicgble codes and regulations. Sworn to before me this c~ ~7 ~ *-Tda of -~'j~ .... 1~ ~ ~ (sram ~--~'~TM ............. ............