HomeMy WebLinkAbout7960-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, 1N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at . Ma..i.n. .~o..a.d. &...H.o.o.r.??..L~.. Street
Map No. ~ ........ Block No.~ ........ Lot No. ~ ...g~..t~]~.o.g~..~...N..~.Y.: ........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... .N.a~....2.~, 19. ?3. pursuant to which Building Permit I~o..~.~.6.0.Z,.
dated ..... .N. Sy .2.$~ . .., 19. ~7~, was issued, and conforms to ~]1 of the reqt~!re-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ~.~.~ .])~.23.d. ~/lg. (y.e.s.$a. ~r.a~.t. ~. W.~.h...S..~)~.e..ing 9.t.~. ..............
The certificate is issued to LO~s..0]m~dO. ~ .~ar~'~..~.~JZO .... .0W~,r~ .............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .p.re.-.,..x.l.9.%.t.ug. ....................
UNDERWRITERS CEt%TZFICATW. No...~p.r.o .~.~..~y .,!.;..X.u~..a.e..k.i.J..,f.m ~./.7..6 .......
HOUSE NUMBER ..... 25', 5f.Q0. Street ...M.~L~..R.0a.d...C.-~t.~.e.l{ .og.u.~. ...............
· ' ~ nspec~or~
TOWN OF SOUTHOLD
BUILDING DEPARTJV~ENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT /(AUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7960 Z
Permission is hereby granted to:
L~ui~..G.~&&o-.~..i{a.r.~.y...~amlllo .................
.............. ~Isln...Raad. ......... C.~t ~h~.~ ...........
to ...~at..£.encing.,...lan~s~apln~..~..pa~/~!~g.]~ff..e.~..~...9...t. 9. ...... ...~..~
at premises located at ..~a.~.~..J~o~il~..~..~b~oo~S..~.J~t~ ..................................................................
................................................ ~utu~ ..... N...Y ..............................................................................
pursuant to application dated ...................... t~:.....2.1 ................. , 19.~..~...., and approved by the
Building Inspector.
Fee $..%.~.,.0C~ ..........
FORM NO. 6
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This apphcation 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 w~th 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 s~te 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:
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 ( /
..............................
New B~lilding ................ Addition ................ Old or Pre-existing Budding ..,x_j~.....~. ...... Vacant/gnd ..............
Subdivision ........ ~,......~ ...................................... Lot No...~ .....
Permit No ...7.~...0...~.... Date Of Permit ...~Z.~.~..~.~.A"~pplicant .....~..~.~...~.......~...~[...~.~ .....
Health Dept. Approval .......... ..~.: ......... ..~....~. .......... Labor Dept. Approval ................................................
Underwrite rs Approval ~.~.~-./....~..~.. ~, ~' J(~-' Planning Board Approval
Request For Temporary Certificate ........................................ Fin~J Certificate ......... ,¢~ .........................
Fee S.bm tted $ ............
.......... /...~ day of .~..7~..//~....~...~..... (stamp or seal ~)/~'~~-~