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.
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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)
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