HomeMy WebLinkAbout7711-z ~OEM NO. ~ :
TOWN OF $OUTHOLD
BUILDING DEPART/~i;NT
ToWN CkERK'S OFFICE
SOUTI'fOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7711 Z
Permission is hereby granted to:
.(~e.~ ..]~m~..... A/.~...~r~C~.~....~.~1~ ............
.............. ;....20~tl~o~[~ ......................... ~ .................
to ...~u;t,%d..~=..&~,d£t ~==..o~..~.~t~ug.'..hu~-,~e s~..hu~...(....~g~;C....~.~..%..~..~.~.~.au-~ant )
at premises located at ...~.,4~..O~.~...i~,..J~.Oa~, ................................................................................
................................................ ~ontholR ....... N.,,~.,.....: ......................................................................
pursuant to application dated ........................... .??~.J) ............ ~. ...... , 19.,~.~.., and approved by the
Building Inspector.
Fee ~5.,.~ .............
Building Insp6ct~f
FORM NO, 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
instructions
A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of alt 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. Approva~ of e~ectricat installation from Board of Fire UnderWriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa*
tions, 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 buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~operty 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 informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5,00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacan'b Land C.O. $5.00
$15.00
Date ........................
Old or Pre e,xisting Building X' Vacant Land ......
New Building ............. ~ .~,..~./ .~.'~,'~ .' .~. ' . .' ........
Location of Property I~ 1~9. · .....
........ ' ' ' Street Hamlet
Owner or Owners of Property .. · ............................
County Tax Map No. lO00Section ..,~,~,, ....... Block ..... ,~, ........ Lot ..... ~! .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ,-~,gJ.J .~, Date of Permit ,Applicant
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Plalning Board Approval ,., ....................
Request for Temporary Certificate ..................... Final Certificate . ~/ ....................
Fee Submitted $ '~' 0~
Construction on above described building and permit meets all applicable codes and regulations.
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