HomeMy WebLinkAbout7793-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PER/V~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 7793 Z
Permission is hereby granted to:
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to .......~...i. ,~...r~.~.~.. ~.~,~.~.a ..g.~.~ge ..............................................................................................
ot promises located at ]~/..,~, CO?..~.O,~. (~3f~6 m~.~...~.q,...~.,/~.)...~(~...g~, ............ i .........................
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pursuant to application dated ............................ ~I~l~IBI%:...~-~Li...., 19..7.~.,'dn~ approved by the
Building Inspector. '
Fee $.'LOm ~
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICA-i'ION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in Wpewriter 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 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 Residepces 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 peoperty 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 required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
{Date ..................... · ....
New Building ~ .... OISor Pre-existing Building ............ Vacant Land .............
House No. Street Hamlet
Owner or Owners of Property .........................................................
Cea nty Tax Map No. 1000 Section '-(-~- Block ~ Lot / ~
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........... Planning Board Approval ......................
Request for Temporary C~ificate ..................... Final Certificate .... ~,~... ..............
Fee Submitted $ .......-- "- ./. '.-~-?. ................
Construction on above described building and perm~neets all app~ab~ cyes and regu ,ations.