HomeMy WebLinkAbout7769-zNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Tow~ Clerk's Office
Southold, N. Y.
Certificete Of Occupnncy
THIS CERTIFIES that the building located at . .A~.~O~*..&..~Nlg~$D~... Street
Map No,hON. StS. Block No ........... Lot No.~ ....... ~O~..N.~Y, ........
conforms substantially to the Application for Building Pe~it heretofore filed ~ this office
dated ........... ~.. ~. ~, 19. ~ pursuant to which Building Pe~it No. ~7~9Z..
dated ............. .~V...~6., 19 .~., was issued, and conforms to ~1 of the req~re-
ments of the applicable provisions of the law. The occup~cy for which this certificate is
issued is ~lva~ .'Oa~..familY. tw~ll~g .wi$~ .a~lttoa .......................
The certificate is issued to ~e2~e. & .~a~ol.B~g~....~s ....................
(owner, lessee or ten~t)
of the aforesaid building.
Suffolk County Department of He~th Approval . ~.*.~. .............................
UNDERWRITERS CERTIFICATE No. ~g~$ ....................................
HOUSE NUMBER .~3~ ........ Street..~9~. ~.~ ............................
8~ Brigaat~e D~
FORM NO. 2
TOWN OF $OUTH0£D
BUILDING DEPAR'I~,~EN~
TOWN CLERK'S oFFIGE
SOUTHOLD, N.. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AU'FHORIZED)
7769
Permission
is hereby granted to:
pursuant to application dated ................... 1'.t~'.....26 ............... h..., 19~.~.., and approved by the
Bui din~ ,Inspector.
FOF,~ NO. $
TOWN OF $OUTHOLD
, 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, o 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), Nan-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
Date ....~..../...~..~....~....~. ~
Bu Id ng ~ Vacant Land ............
New Building ................ Addition ....~ ...... Old or Pre-existing ..............................
Location Of Property .~ ~.., ~ ..~...~
................... ....... ...................................................
,L/-, ~:~-. ~:)' /)_~2, ,~ ,~ .~'. ,. L! ~' .............................
Subdivision ~.~..~:..Lot No ..... ~...... Block No ............. Ho, use No .............
Parrot No ..~.~...~...~.~., Date Of Perm t .~Z~?~.~l.~.~,..'A-plicont ~:~.,~4_
Health Dept. Approval ........ ..................... Labor Dept. Approval ............... /..¥..~.~..t ....................
Underwriters Approval '.~...~r~..~....~.../....)~.....~.. ............ Planning Board Approval ....... ..~....!..~. .....................
Request For Temporary Certificate ........................................ Final Certificate
Fee Submitted $ ._~
Construction on above described building and permit meets all a_pplica~l ~.~odes and regulations.
App cant ...~....~ ~~
Sworn to before me this
...2~..-.~.~.. day of ....~...~.~.~. .............................
Nota Coan
~ota~ Public State of New Yo~
No. ~2'7267800 Su~/k Coun~
tTerm ~lres Mer~ 3~, 1~