HomeMy WebLinkAbout9240-zFOF, M NO. ·
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No..Z78Zl ..... Date ........... Aug ..... t(~ ·., 19..77
THIS CERTIFIES that the building located at . .E/S. ~fassatt .Foin2. Rd.... Street
Map No. ~[a~s, - P.t, · Block No .......... Lot No,2~/26 ...... Ou¢ehogme ..........
conforms substantially to ~e Application for Building Permit heretofore f~ed in this office
dated ......... 0c.t.. 20., 19.76. pursuant to whi~ Building Pemit No.9RWOZ..
dated ....... h~. ~0..., 19.7.~, was issued, ~d co~orms to ~ of ~e requ~
merits of the applicable provisions of the law. The occup~cy for whi~ ~ certificate b
issued is . Pr&vate..acce. s sor~ garage ..... (~roved..by. Bd .Appaals) .........
The certificate ~ issued to ~al~er Sch~dt ..... O~m ........................
(o~er, lessee or ten,t)
of ~e ~ores&d building.
S~olk Co~ty Depa~ment of Heal~ Approval ~, P. .............................
UNDERWRITERS CERTIFICATE No. -I',~{v. .......................................
HOUSE NU~ER -~365 .... Street .. t~a~::au -P~- i~6. ~ead ....... Cu2eho~ue.
B~ld~g I~pector
/
FORI~ NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFIGE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9240 Z
Date ........................... Ji~ ....... ~0 ......... , 19~..
Permission is hereby granted to:
....... :: ..... J. .............................. t/8..lhssa~..~t..l~a~ ....... ~t~o~u~ ..................................
~/ ~'* ---~ ............. ~ · ..~. ........................................................ ; ....... :.; ................... ~, ..................................................
,- - ~ p~Hant t~ a
~ ...... ~,:,~ ..... . ,~ ~p!icati°n- dated , ......................., ,, .t~j.~....~. ............... , 19..~,,, and approved by the
B~ilding Inspector.
FORM NO. 6
TOWN OF SOUTHOLD
Building Depa~tment
Town Clerks Office
$outhold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ,nk, and submitted in triplicate 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-0 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 cerhhcote 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 buddings (prior to Aprd 1057), 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 inspechon 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 ,~ (/(, ..~ i 7'~
Date ......................... ./. ...............
New Building ~ .. Old or Pre-existing Building ........... V nt Landj ....
Location Of ;;~:~"::'~'"'"'/'/¢'~'~'"~'"~"~-- - /,.w ,,:.. , / . "~'-"'~ .4___';;~"~;""~"~"~" ...... ~ ...........
Owner Or Owners Of Property ...~4..~.../.~....~....]t~.......~--)...~.~..Lw~../..~..(~...~....... ............ .....
Subdivision ................................................................ Lot N~oo?./...J.~.~B~ckNo .............House No .............
/0,77
Permit No..~.c~....t~.~..... Date Of Permit ..~...~..~t. ..... ~pplicant ..... .~..; ......... ..~......'. ................. .~...~.
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....,'~.,...~ .................
Construction on above described building and permit meets la~l appli.ge~le co~es and regulations.
Apphcant .......................................
Sworn to before me this
...... ........................
Notary Public ~-. ,~.'..~/,~t/~Y~ ....... County