HomeMy WebLinkAbout7749-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No. Z%. ~.~. ...... Date ............... J~a~e.. 2.0..., 19.~.~.
THIS CERTIFIES that the building located at E/S. Nain. f~o~4..(~a.~l ... Street
Map No.. Z~ ........ Block No .... ~ .... Lot No, .~...~99~q~...~ e~'.. ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... ~a~ ... ~ J,., 19.7.~ pursuant to which Building Permit No... 77~:9Z
dated ........ Nar .... ~; ..... , 19.7~, was issued, and conforms to all of the req~e-
ments of the applicable provisions of the law. The occupancy for which this Certificate is
issued is . P~iva~a .ace.esao~ .b~ldi~ ........................................
The certificate is issued to .. ~.ah~. Yavorl.a ....... ~e~ ..........................
(owner, lessee or ten,t)
of the aforesaid building.
Suffolk County Dep~tment of Health Approv~ .. N.,~, .............................
UNDERWRITERS CERTIFICATE No. p~d,~g .................................
HOUSE NUMBER .... 5~930 .... Street ....... Main. Eoad ........................
... ~OTE~...Th~ .is. not. ~o .be. ~sei as. se~era~ .dw~l~g .,~15 .~nd..~0..
have no cooking facilities. ~ , ~'~
......... f~J(~ ~. ....
Building Inspector "'~'.~
FO]EI~ NO. 2
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? 7749 Z
Permission is hereby granted to:
............ ~ ~hlx.. ~.~lla*. O.V& c .....................................
......... .5:.~.(~&O.....~:~.~.. 2~ ................................
SoutholCl
to ~.c.~....~.....a..~:~.~..~m....°.~...~`~.~n~...~.~c.~`~.~:..h~.~.....[~..~.~k~m.~.. ccok~,
at premises located at .~/...-.~ , [;~J.~, ~.Oa~Cl ........................................................
............................................................ ~ D.~ ~fJ.~ ~.~. ....... ~ ..*.~.., .................................................................
pursuant to application dated .........................~'?..~L.I'..e.~. ....... 1.~ ........ , 19.~..~..., and approved by the
Building Inspector.
FORM NO. 6
TOWN OF SOUTHOLD
~ Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR 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 dispasal--(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 compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
D. For existing buildings (prior to April 1957), Non-conformihg 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
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 15)75
New Building ................ Addition J Old or Pre-existing Building ................ Vacant land
Owner Or Owners Of Property x/'~ F//L/ /~'/ A ~///~ (,) ~ {
Subdivision ........................ '.7........~ .............................. Lot No ............. Block No.....~T.. ...... House N........, .... O
Permit No. Date Of Permit ..[/~ ./.~ ~pplioant
Health Dept. Approval ............................................ Labor Dept. Approval ...............................................
Underwriters Approval ...4..-~..~...P..L.k/.....~?. ................ Planning Board Approval ......................... : ..............
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ .................................
Construction on above described buildin~0.~d p~'ml, T~tS all applicable ¢ode~ and regulations.