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 ......... ,~