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HomeMy WebLinkAbout7750-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Oilice Southold, N. Y. Certificete Of Occupancy No.. Z6.579 ..... Date ............. Sep. t~....~2 .... , 19.?~. THIS CERTIFIES that the building located at .. ~f/.8. l~e~ .~. ~Q..( [~e~t) Map No. ~ ........ Block No. z~ ...... Lot No..~ .... ~. ~ffD~..I~,X,... conforms substantially to the Application. for Building Permit heretofore fried in this office dated ........... Ea~' · ~4. ' ', 19..~ p~suant to which Building Permit No.. ~.~.. dated ............ ~...~ .., 19.~., was issued, and confoms to ~ of the req~ ments of the applicable provisions of the law. The oceup~cy for which this certificate is issued is P.~I~ .9~,~ .~Y. ~lyf~g .~$~ additio~ (~oved b~ ~ appeals) The certificate is issued to .. RoBe~t. Gold~se ..... ~r ......................... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of He~th Approval . ~ .............................. UNDERWRITERS CERTIFICATE No.. N2~202~ .... A~.. ~.. ~.~ .............. HOUSE NUMBER .. ~30 ....... Street ...Ne~ .~.Colk. La~e..(~ ~) ......... B~ding Inspec~ TOWN OF SouTHOLD BUILDING DEPARTM£NT TOWN CLERK'S OFFICE sOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) ?750 Z Permissio~ is hereby granted to: ........... ~e~... Su££o.Zk .......................................... to ~u~d...a~..a~&i~£or~(.S.)...oau..a~ls.~ir~g...d~e3~Sdag......(~p~e.~.. h~r...~..~pp~ ~ s ) at premises located at .aj/f~..~,t,..~.~tk...La-ne..-(..~b;--G.t,.) ..................................................... .................................................. · ~ e~ ~u-f.$e-~k...-..~., .~,, ........................................................... pursuant to application dated ..................... ~. ..........~.~ ............. , 19~.~,..., end approved by the Building Inspector. Fee $:J..~, (2,0 ............ / ' Building ~spector / FOl~f NO. G TOWN OF SOUTHOLD , B.ildlng Department 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 o11 buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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. B. For existing buildings (prior to April 1957), Non-conforming =uses, or buildings and "pre-exist'nB' 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. gate 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 .............. Owne Or O ner Of Property ...... .............................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No..~.~.~.~ Permit No..~.~.~..?..?~,... Date Of Permit .~.?././..?.~.~.....Applicant .~?,J~...~...'~..Xr. ~,,~.~.~. ~..~/: ............. Health Dept. Approval ..... ...~.../../~. .......................... Labor Dept. Approval ...... .~..~..,.~ ............................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....... :/~<~ ..................... Fee Subm.tted $ ....4.,..~..~ ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ........ ~.....~.~...... ........................................................ Sworn to before me this (_,__~ ~7 ........ /,..>.. doyo ....... ,,tampor sea,, BOARD 'OF,FIRE UNDERWRITERS BUREAU OF ELECTRICITY[ JOHN STREET, NEW YORK, NEW ¥O~K 10038 ~ .Mari~ Ben~ck;~New Suffolk,Road, Oak ~&'Wicks~S '4, ' ' ,I ~ ! Il II II ~i t; ,~ !: II ~I :~ ,i ,Il !I Iii I' ;~~~ ~ ;; ', 'h '{~ ~'~ ,~ , I I,, ,~ Th,s cethflc~te musf not ~e;ohered ,n,ony monner~ return ~o the off,ce,o~ the Boord ~f ,n~orrect, Inspedors moy ~¢ idenf,~led b~thelr creaenhels, ~ Well c , ? c t RCu,T q, Td,~t:'-5 /..v Celica. .