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HomeMy WebLinkAbout8340-z· ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .¥ill~ge. Lane ............. Street MapNo. ~ ........ BlockNo.....X~. . LotNo .... ~...0.r.i.~.n$...N..,.Y.; ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Dee, 1 ~, 19. ?~ pursuant to which Building Pemit No... dated .. De~ .. l~...., 197.5., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~iYa.to. one .family. d~w~lling .with additiori .................. The certificate is issued to . .f.,. M..oo.r-.J.ar~..a.~$k% ......OwTaer ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. N.,R, ..................... UNDERWRITERS CERTIFICATE No. pending .................................... HOUSE NUMBER .. 7t ~ .... Street . .V.i.l.~.g~..La.~e. ....... .0r.%~.t ............ Building InspectOr TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN ~LERK'5 OFFICE $OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) N? 8340 Z Permission is hereby granted to: ............... ~.~..~.~. ............................................... at premises located at ..... .~.~,{~J~...~{~ .......................................................................................... ............................... '. ........ : .......... : ...... O~£~xt ....... ]~,~. ....................................................................... pursuant to application dated ...................... ]~1~ .....].~ ................ , 19.~.~.., and approved by the Building., Iqspector. Fee ~'"~ .e~ .......... FORM NO, 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions 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: ]. 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 comphance 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 end "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: 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 ......~..~,~.. ,~..'..~.....,~......../....~...~...~. · ..... New B~ilding ................ Addition ...~ ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......~..~..~........~....~. ......................... ..~..~...~.......~.~-~.-.'. ...................... Owner Or Owners Of Property .,.~.c..T..~../~...~,~...~~..~... ....................................... ~ Lot No Block No House No Subdivision ..................................................................................................... Permit No..~...~..~,..~....__~..... Date Of Permit/.,~..//.~/..~..~.Applicant · ..~...~...~~~ ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters A~proval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~ ............................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. ................................................. Sworn to before me this Notary Public .~.,~....~...Z...~./~County FLOYD F. KINg, JR, Notaw Public State o1: New York No 52-7267800 Suffolk County Term Z:'pJros L~Frch 30, ~97~