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HomeMy WebLinkAbout7768-z · o~ ~0. ~ TOWN OF $OUTHOED' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) 7768 Z FULL Permission is hereby granted 'to: ~o~e'~e"~'~n~o~ ............................. ~ ................ ...... -~e'ho'g'ue ................................................... to ..!~.B~,~ .,/,t ~.~... a,C C~ s~or~.., h~-~.~ cl.i~ ..................................................................... at premises located atLQ~;....l~ ....... ~[Ilt~.T~'...~J~.--, ............ ~. .................. : ........................................ ............................................... ~lmo.~.y...L~oed .............. ~3~tt~h~u~ ..................................................... pursuant to application dated ..................... ~I'..-...~- .................. 19~. .... and approved by the Building Inspector. Fee $$.~).~0.~ ............ BuildT~g InspeCt 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 in duplicate to the Building Inspec- tor 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 featu res. 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 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~perty 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 requ ired to prepare a certificate. C. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling $ [ 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date..' ./~. ~. ~.~.,~.~..~..?.. New Building . ~'~ .... Old or Pre-existing Building. ............ Vacant Land ............. Location of Property ....... House No. ~ ~ Street Owner or Owners of Property County Tax Map No. 1000 Section ............... Block ............... Lot ...... > .......... Subdivision ......... ~.. x~.. ~.:..Filed Map No ........... Lot No..; ........... Permit NoJ~:~.. Date of~ermit ~/~Applicant Health Dept. Approval ... W... Z .... ¢¢/.~/.~ 7. Labor Dept. Approval .... ~.Z,~ .......... Unde~riters Approval ..... ~/ ............ Planning Board Approval ..... ~': ........... ~equest for Temporarg Certificate ..................... Final Certificate .. ,~ ............ Fee Submitted $ .... ~. ~; ................... Construction on above described building and~Wt/nit meets al/L,~ppl/~ble c~:~les and regulations. Applicant ............... Rev. 10-10-78 FOI?-,M NO, 6 TOWN OF SOUTHOLD , Building 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 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 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 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $$.00 3. Copy of certificate of occupancy $1.00 - Date ....... .?./.7¢.....~ ~..?~ ............ New Building ................ Addition ................ @!~ ~."~ Building ......~. ......... Vacant Land .............. Location Of Property L-~/~'¢'~/ /'~J .................. z"";~' ......................... t.., ...... ¢. .......... : .......... .'.,x. ....................................... Owner Or Owners Of Property ........ ./~[~O../..~.ff..ZZ ...... ~.. ....... ~..~..,~.[.~.~.~./.:~,'!..~'. ............................................ Subdivision .... ¢~....¢.'?.. ~'~ '~""~'/~ ~t.::- ,L¢...~.f~ ..... Lot No.......~..... Block No ............. House No ............. Permit No. ~7~> ~' Do,e Of Permit ~.~.~..~..]:.~:..'~Applicant .- ...... ........ ..... Health Dept. Approval ............................................ Labor Dept. Approval . - ..... Underwriters Approval .............................................. Planning Board Approval C.,,,.,e ........................................ C.,,,,.. =================================== Fee Submitted $ ....~.~;..-%. ........................ Construction on above described building ancJ~ermit me~ts all applicable codes and regulations. Applicant ......................................... Sworn to before mL~s ........ Notary Public ......... ,~