HomeMy WebLinkAbout7994-zNO. &
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No. Z77. ?. ...... Date ........... .J.u~..e .... .2.7.., ,, 19 7.7..
THIS CERTIFIES that the buildLng located at ...1.!i.n.e.hah.a .B. 1..v.d .......... Street
Map No. xx Block No. xx Lot No. ~ $outhold l,i o ~2.
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..... M.~y..~.~.., 197..~ . p~zrsuant to which Building Permit No..7.9..9.hZ..
dated ...J .m3.e..1.3 ..... , 197[.., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is private storagel~ool ,~htd) building (azproved by bd appea s)
The certificate is issued to ?!u.g.h. ?!e.¥~. a.r~ ..... 9.w?e.r. ...........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval '~.'. v- ................
UNDERV~RITERS CERTIFICATE No I- -~
FORUM NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN GI.ERK'S OFFIGE
SOUTFIOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PHEMISES UNTIL FULL
COMPLETION OF THE WORK AU'FHORIZED)
N? 7994 Z
Permission is hereby granted to:
....~...~.~.~' ......... ~ ........ ~..z.;:.t.v...~.~.! .....
at premises located at ..................... ~../!..t..bJ..,N(,.£....H.../~.....~1 .~.. ........... ~]~.L.~.'..~:~ ..................................
................................................................................. ~'..O...~.. ...... u.z~.~ ...........................................
pursuant to application dated ........................~ ..... ~ ....... ..~.J ......... 19~..,~...~ and approved by the
Building Inspector.
Fee $ ......................
Building Inspector
I~O][~M NO. 6
TOWN C~F SOUTHOLD
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Inst'ructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
inspector with the following; for new buildings or new use:
1. Final survey of property with accurate Iccation 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 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
Date ..................
New Building ~ ....... Old or Pre-existing ~ld~g ........................ ~:}Vacant Land ............................
Subd~vis'on ............... ~ ............ ~ ......................... Lot No. ~. Block No.......~.... House No .............
Permit No. ,?..~,~,.~,.,.~,., Date Of Permit ....,~l/z~,/~.,~,Applicant .......... ~.~.,~~ ..........
//
Health Dept. Approval ..... .,.~,,,,~ ....................... Labor Dept. Approval ¥,. ....... ,~,,,.,/,.,,~,. ........................
U.derwr,te Approvo, ........
........................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ,,%~..,. .............................
Construction on above described building and~. ~;~ / ~..,Pen~it meets all applicable codes and regulations.
Sw~)n~efore me
......
.... C~.,~. day of ...