HomeMy WebLinkAbout7961-zFO~t~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificnte Of Occupnncy
Noz6932 ....... Date ............. 1~:~...$5 ...... , 19..7.6
THIS CERTIFIES that the building located at . Ous~;e~ ,,~e ............... Street
Map No. 't~a~.r¥iew..p~loek No ........... Lot No, ~.l ..... Soutl~o~,d../~ .¥~ .........
conforms substantially to the Application for Building Permit heretofore fried in this office
dated ........... ~'.'ay' · '29', 19.?~, ptt~suant to which Building Pemit No.
dated ...... l~iay,, .29. , lg.7~., was issued, and confoms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .A¢¢e.s ser.~..l~u~],cl ~.n~, (Gr. eenhous.e ) .................................
The certificate is issued ~o . Lo~i.s - Bode. & .g[fe · ownere ....................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval E,i{. ............................
UNDERWRITERS CERTIFICATE No..I~..R, .....................................
HOUSE NUMBER .... ~ 0 ..... ~,~ree% .. ~:u~;~ · Awe ..... Sou~,,hold .............
Building Inspector
FO~ NO. 2
TOWN ~OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to:
at premises located at ~*~;.:~......~1;~i..;-;...; ......... l~;~.~....~3~8 ................................................................
...................................... i ............... L:.~,u~.t;~ r...A.v.e ........ ~.~.~,~.:L~.....~.,.~:., ......................................
pursuant to application dated ........................... ~,~ ........~.~ ...... , 19.~.,~..., and approved by the
Buildi,ng Inspector.
Fee $:~..(~. ...........
FO~ NO. 6
TOWN OF $OUTHOLD
, Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This opphcation must be fdled m 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 oil 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, Mulhple Residences and similar buildings and
installations, a certihcate 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 19§7), Non-conforming uses, or buildings end "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 buddings.
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 .....· .~. · · ./.../....~.~/. · ~. · ..~.. .................
New B~ilding ................ Addition ................ Old or Pre-ex~sting Building ................ Vacant Land ..............
Lacat,on Of Pr erty ...... ....... ...........
Owner Or Owners Of Property ..... ~..~..~../.~.....,~..;..~...4~...¢~.~.....~....,~..,. ................................................
Subdivision ~--'..g..~.C~/-~-/~...~..g~-..~'. ................. Lot No....~./.. .... Blo~k No ............. House No..c,~....~.,.
,o o, ..................
Health Dept. Approval ...... ..~./~ ....................... Labor Dept. Approval ....... ~..~...: ........................
Underwriters Approval ........ ...~../../....~..~ .................... Planning Board Approval ...~./....~......; .....................
Request For Temporary Certificate ........................................ Fino. I Certificate ....... ~ ........................
Fee Submitted $ .... ~ .......................
Construction on above described building and~ermit~ meets.,all apj~licable codes and regulations.
Sworn to__beforeme t,~/~. ,~.,,.,~ '~,?,,..~,,
(stomp or seaD ~'~'/~F) ~