HomeMy WebLinkAbout7963-z FO~M NO. ~
TO~'~ N OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7963 Z
Permission is hereby granted to:
.C~13~..Ctoz~z~r.~c.t~u~z~.Cozp.....A/.C..]~ez~t & J~tith Bo~.~a
............. ~.m~tk~t~. ............................................
to ...~.1~,i 2...n~W...Q~.. ~.~m;L l~....~.g.l 1.$.~. g .................................................... : ............................
at premises located at ...l~.~..~;~]=~..~-3~f~ .........................................................................................
................................................... P~c~.e ..... ~,~.~t~ ..............................................................................
pursuant to application dated ..........................]~r ....... 3.0. ............ 19..~.., and approved by the
Building Inspector.
Fee $..:[~:. .......
Buildi~
FOIkM NO. 6
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
$outhold, N. Y. 11971
AFPLIGATION FOR CERTIFICATE OF OCCUPANCY
Instructions
^. This application must be filled ~n 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 buddings, Industrial buddings, 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:
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 ~.~.
Rte ...................................
New Building .... i.~.. ...... Addition ................ Old or Pre-existing Bui~ing ................ ~XJvacant hand ..............
location Of Property ..... J~... ........ . .~...~....~.....(~... ............. ~..'~.....?..~.~.~ ........................
Subdivision ......... ~ ................................................ Lot No .....~.. Block No..,.,~,.. .....House No.J..ff....9./~
Permit No. Z,,~,,.~.,,~.. ..... Dote Of Permit .....~.'~..~,~ppplicant ..... 8~.,~,.~...~,~,.C~t~, ............
Health Dept. Approval ~/J..~/Z,~.....~. ..................... Labor Dept. Approval ............. ~..:..I.~.;~. ...................
Underwriters Approval .~.////...Z~.'...,.. ...................... Planning Board Approva ..... .................
Request For Temporary Certificate ........................................ Find Certificate
Fee Submitted $ ..~...~ .....................
Construction on above described building and pe~, it meets qJl apEI,cable.~codes ancjL, r~gulations.
Applicant ............ ~ .......... ,...~ ..........................
Chief of General Engineering
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LIVING ROOM
FAM JLY' ROOM
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KITCHEN
DINING gOON
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P1 IIJL LANE'
ELEVATION
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LINE
FLOOR 'L~NE
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