HomeMy WebLinkAbout7988-z FOI~ NO, 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTI'K)LD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7988 Z
Date ........................... ~T.3z,~e .... 9 ............ , 19.~.~..
Permission is hereby granted to:
............. ~f, E6~L'6 ............................................
to ----b~t~-,e~-.~d~f~ic~.-~n-.~x--ks~c~n-g,.ct~e~,Ing- ...........................................................
at premises located at '"'~'.~'~'""~&~"'A'9'e' ......................................................................................
............................................................ · ~es¢,--}(~, ~.e~t ....... t~-rT~-~- ........................................................
pursuant to application dated ...................... .~]r~t~.....~) ................ , ]9.~,~.., and approved by the
Building Inspector.
Fee ~'~0' ............
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
, Buil~.ilng Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
I nstructlons
A. This apphcahon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
Inspector w~th the following; for new buildings or new use:
]. Final survey of property with accurate location of all buildings, property lines, streets, aha
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 installahon from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Mulhple 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 hnes, 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 certifk:ate.
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 Building ................ Addition 2~' .~.....~....~.. Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ...... ./.~.....~....~.. ..... ~...~.~.. i..~..~...~.'/~..~'~ ....... ...~....~.,~.,.~...~../.~...~',,....~...~. ..................
-~ . ~ % ' //9° ,' o '
Owner Or Owners Of Property .~,4~.~.. ....................... __~ ................................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No ...........
Permit No ....2.~..;.~....~.. Date Of Permit ..... L~.~/.; ...... Applicant ~/.x.~./.~
Health Dept. Approval ............................................ Lobar Dept. Approval ...............................................
Underwriters Approval ...~L...,4...~.'.~..~,.~..~.~. .......... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ FinaJ Certificate ............ ~...~....~....~'.. ...............
Fee Submitted $ ....................................
?
/
Construction on above described building ar~ permit meets all applici~le,codes~cln~ r~gulaho~ls.
.............
Sworn to before me this , -7 / ~~C
· ..2~.¢ ..... d=y of ~.d ................. ~.~. ............ ~ ~ (s o~n ~ s~ ) . ~_
No'a~ Pubhc ~~Coun~~ ~ ~/[ ~}
~ Public, Sta~e of New Y~ ~ ' /
No, 5~.6544380 /
; ' Dualif~d in Suffolk Coun'9~