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Home My WebLink About7740-zTOWN 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? 7740 Z Permission is hereby granted to: ........ .~/~ .......... ~.~..,.Z~ ............... ,o ~.~.:~:....~(.,..~?..~.~ ..~.~... ~.~..). ....... ~?..~L....~c.(..z~,.~.~,...~ ...... .... i i.~%~/. ....... ~.i':. .,~ ?.).. ....... .~ ~ .................... : ................................................ ~.. ......... at premises located at ....................... ..~.,~..~;...r~..~.~.!..?.~.. ......... ~.::!....~...C.-. ........................................ ~0~ '7' tto purs.o-~ to opp~ico~o, da~ed ............................... :...~/....¢..~/../!...?~., ~¢..Z'~ and approved b~ th~ Building Inspector. Fee $/..g.~.~ ........ · Building Inspector FORM NO. $ TOWN OF SOUTHOLD , Building Department Town Glerks Office Southold, N. Y. 11971 APPLICATION FOP, CERTIFICATE OF OCCUPANCY Instructions 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: 1. 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 complionce frorn 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: 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Vecont Land .............. Location Of Property .......................... ; .................. : .......... · ................................................. z.~.~..~,....~ ........... Owner Or Owners Of Property ..................... ....................... : ........... :.'.: ........................ .~... ........................ Subdivislon .......................... ; ..................................... Lot No ............. Block Na ............. House No.. - ................................. .......... Permit No....7..~.Z.~./...~..?-.~ate Of Permit. ~..Applicant ~o-~..~..'..~..-~z?.~? Health Dept. Approval ................. Z~. ....... /.~. ........... Labor Dept. Approval ................................................ Underwriters Approval .................................. P~annin§ Bo~rd ApprovoI ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate ~'~"~ eeSubm,tted* ...... .............. Construction on above described building and permit m~ts all applicabJ~ codes and regulations. Applicant ................... .~ .~. ~..~......~. ~ ......................... Sworn to before me this / Notary Public ................. County -/ (stamp or seal)