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Home My WebLink About8337-z FOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8337 Z Permission is hereby granted to: ..~......~.e..$.[~z..~....s..o.~.......~...~.....~ .. t~..t3ze ......... ~..t.~.~..~ ................................................. at premises located at~O.~S..~.~.~ft~3 ....... ~O~l~O~ ................................................................ .................................................... ~/~..l~,~l&~..l~e .......... I~.~. ~,f,~e~ ............................................. ........................................................................................ ;...,.-;.;.; ............ ; ................................................ pursuant to application dated ..........................,..~....~. ............ .~...~, ..... , 19..~,~..., and approyed,,~ by the Building Inspector. Fee $.. ~ ........ FOI~ ?~0. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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 cerhf~cate 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 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: I. Certiflcote 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 New Building ................ddition ................ Old or Pre-existing Building ................ Vacant I-and .............. Lacat~on Of Property ...... [. .................... 7' ........................................................................... 7 .............. Owner Or Owners Of Property ..... .;~.~.~...~.;~ ....... .,.~..~.[..,C..~/....~....~...(~. ........................................................ Subdivision ................................................................ Lot No. ............ Block No ............. House No ............ Permit No...d~..~....~..."/....~7. Date Of Permit ./..~.?../...~/~lT..Applicant ~-]....~.....¢..../...~..~.J~:....~..~.:e...~...Z ...... /...~...~... Health Dept. Approval .../~./;~.~/;?..~ .................... Labor Dept. Approval / Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ ....... ...~..'.~...~. ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant Sworn to before me this // (stamp o, seal) ........ day of ..... ....... Notary Public .......... ~..~. County · _m--u ......... . ...... ,~,, u~ ,,,hhuon to' th~s surv'e~' is c~ vloJahon ot sechen 7')09 of Chief ~ ~ener~l Engineering Sca-iceS ~ ~ ~0~ 6~ t I I ' m. I~ ~'" , AVE. All d,stonces to well~ ond cesspools by Iocahon flora ~,ou~e o~,r-~s ~pd field l~' .,, pcoJS cr~ not ~,.l~Je thesD d,m~nslons cannot be cerhJled · URVEY FOR TOWN ~ SOUTH~D ~FF~K COUNT~, N.Y. ~o~4v~i~ ' * L FEB. 3,1976 ............................ , ...... eiV~a~ ~,Y. . BUILDING DEPARTMENT AT