HomeMy WebLinkAbout9222-zFOB, M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
28
No. ~77.~.8. ..... Date ........ ~.~e..~. .... , 19..~?.
THIS CERTIFIES that the building located at . .]3r.a~. A. ve ........... Street
Map No. G....!...~.u..~.h.~.~.~Block No ......... Lot No, . .~?.~.~.8 ......L.a.~.~.e~ ..............
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...... i',~ay ....2, 19.7.?. pursuant to which Building Permit No...,a.2..~.2.~.
dated ...... l,;a.y... 2...., 19 7?., was issued, and conforms to all of the req-ire-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. ?.z-~v~te. 9.ne..f.~r.,~.ls,.'..d.w.e.].]..~ng. !.:~.1~ .h ad,~$.'c.i.q~ ....................
The certificate is issued to . . P?..a.a. id .~: .0..1.e?.a....~:.e.]:.e..s s..a?.~. .... .0.?.e?.s. ...........
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ~(. R · ........................
?.~. ~ ~.~.? ...... ..r.u..? .....................
UNDERWRITERS CERTIFICATE No.. ~3 3 ',~ -n~ 21 1977 .
HOUSE NUMBER . .. 1 ~'.~.0... Street ...... ~.r~y...,':'[¢.- ..... i.~.~.u.r.e.l. ...............
·. t/.'~.' /. :' '. . :...' . .~. . . .1 .....
Building Insp~6tor
FOP~i~ NO. 2
TOWN OF SOUTI"[OLD
BUILDING DEPARTM~:NT
TOWN CLERK'S OFFiCe:
SOUTH'OLD, N. Y.
(THIS PERMFI- MUST DE KEPT ON THE P~EMIqE$ UNTIL FULL
COMPLETION OF THE WORK. AU-FHOPdZED)
Z
Permission 'is hereby granted
premises located ct ~ ..... ~,,~..~:~.~....~;L.u~'~.G,~,~L,.~:..£~;~
....................... ~"-'~. ~: _,',.'~ .~ ~:,.Z.?. H. ~ ..........................
p~s~an~ to application dated *'" ' ' '~ '
';~¢. - ' 19....~.~., and opprovea by .the
Dui[ding; Inspector.
Fee $.~.:~.,.~.~ ............
I~ORi~ NO. 8
TOWN OF SOUTHOLD
, Building Department
Town Clerkt Office
$outhold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This apphcation must be filled in typewnter 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 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 cond,tion 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:
I. 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
~te~. . a~. 7'/
New B~ilding ................ Addition ..X .........Old or Pre-existing Building .....
O~ner Or ~ne~ O~ Property .~~.......~...~~..~..~...~.~ .............
Subdivision ................................................................ Lot No.~.....~.~. Block No ............. Hou~ No .............
Health Dept. Approval ............... / ........................... I~abor D~t. Appro¥o! ................................................
Underwriters Approval .~/a!../.....7...7. .................. P,onn,ng Bo~rd Approva, ........................................
Request For Tem~.~ ~ficate ........................................ ~in~ Certificate ...~ .......................
Fee Submitted $ ...'~,,
Construction on above described building and permit meets all applicable codes and regulations.
Sworn to before me~s.. ~ Lf
...... o, .....
(stamp or seal~
~VE t
$.:j]F.: 4¢"~ 1"
i'
APPROVED AS NOTED
DATE, ~l,~
765-2660 9~M