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HomeMy WebLinkAbout8336-zFO~N& NO. & TOWN OF SOUTHOLD BUrLDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6.9.~8 ...... Date .............. Karck..26.., 19.7'6. La THIS CERTIFIES that the building located at ...... .M~dd/.~. ~Oad. ~%..Q0~treet Map No..~ ........ Block No. ~ ...... Lot No, . ~.. ~9.g~...~ ~Y., ........ conforms subst~ti~ly to the Application for Budding Permit heretofore f~ed ~ this office dated ........... Q~c. ~ J , 19.~g. p~suani to which Building Pe~it No.8~65... dated . .......... Dec ~2 , 19 .... 7~, was issued, ~d confo~s to ~ of the req~!r~ ments of the applicable pro,ions of the law. The occup~cy for which lhis ce~ificate is issued is . .~%~ .~4~g. (~7.~. ~. ~9~ge.~.. w~.~. ~.~ ................ The certificate is issued to . .~b~. Pfe%=ewlcz.. . ~e~ ..................... (owner, lessee or ten,t) of ~e ~oresaid bulldog. S~olk Cowry Dep~ment of He~th Approv~ N.,.E, .............................. UNDER~ITERS CERTIFICATE No. ~ ~ ~ ....................................... HOUSE ~BER . 2~ .... Street .... ~,~4~9..~9~. (~) ................ ~55 Cox L~e TOWN OF SOUTHOLD 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) N? s~6 z Permissiqn is hereby granted' to: TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s opphcotlon must be filled in typewriter OR ~nk, and submitted in DUPLICATE to the Budding Inspector w~th the following; for new buddings or new use. F~nol survey of property with accurate Iocahon of all buildings, property hnes, streets, and unusual natural or topographic features 2.Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3.Approval of electrical installation from Board of F~re Underwriters 4 Commercial bufld,ngs, Industr,al bufld,ngs, Multiple Residences and s~mflar buildings and installations, o cemficote of Code comphonce from the Architect or Engineer responsible for the building 5Submit Planning Board approval of completed s~te 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 all property hnes, streets, buddings and unusual natural or topographic features. 2 Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 3 Date of any housing code or safety inspect;on of buddings or premises, or other pertinent formation required to prepare a cert~f,cate 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 I_ , - ~_ ~ ~ Date ..~..l~.~...~/....,~, ...~..~..6 ............. New Building .............. ..,~Add~tion ..../.~ ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property/~).,k~.,.~..,~.....~~. ~....~...~....~.~...~~ Owner Or Owners Of Property ..... L~. ~....//.../..~.~ ................................................ Subdivision ............... i...~ ...................................Lot No...' ......... Blockl~klo .......... ~.; House No......."~"~. .... Permit No ................... Date Of Permit .................... Apphcant ...... : ...... Health Dept. Approval ...... /¥.,..1~.~. ....................... Labor Dept Approval ....... /.~...~...~.. ............................ Underwriters Approval ..... J~..'/..('..? ......................... Planning Board Approval ....~....~..~.? ............................ Request For Temporary Cert,f,cate ~¥~..../ .................. Final Cert,ficate ..... ..~. .............................. Fee Submitted $ ....~.~,....~.. ................ Construction on above described building anj:l..pe/crn~t ,r~ets all j~pphc,~able codes and regulations. Applicant ............................................ Sworn to before me this (stamp or seal) $699*~gZ--aol~O ~E:6~,I. ~EIOA ~A3N ';r~oHO.LrlO tl;l(]llrl;I ; tIO.LDVtl/NOD I)'ISAAO'-I~O B3/$3HS)