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Home My WebLink About9244-zFOB,M NO. · TOWN OF SOUTHOLD BUH,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z5,0.t.~ ...... Date ........... ~0.v.... 2.1 ....., 1g.7.7.. THIS CERTIFIES that the building located at (1207~)..i~Iob,;on ~;'.~..N./8. .... MaiUstreetROad Map No.. ~:x ........ Block No..xx ...... Lot No..;'..x ....Matt.2t'ack. · .N,Z., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~:a,~;...1.3 , 19. ?.~. pursuant to which Building Pemit No. 92~.J.~2~.. dated ........... l. Ia~...~... , 197.7.., was issued, and confm:ms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is PI'.f,v.a.%~..o~e..fa~',$1ff. ~:'.e.~,%$r(g ...................................... The certificate is issued to ~$~A~.~m ~?c. Panner. ~'~che ...0wna~.m .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~ o~., (Elebuil L .dv, eliLing) ......... UNDERWRITERS CERTIFICATE No ..... A~pz'o.v. ed. b~: .~,./~,ubacl~..1.~./.~ 8/.7.7.... HOUSE NUMBER - 3~ .... Street . P. vt. Rd..#2(1. YJohson. Lane .... lgOlgM NO. 2 TOWN~ O~SOUTHOLD BUILDI N~G DEFARTMENT 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? ~'9244 Z POEM NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southo~d, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in 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, 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 installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a cert,ficate 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 Date · -/- .~//~. · · .l~- · - .~-- - ................... New B~lilding ................ Addition ................ Old or Pre-existing Building ...~.. Vacant Land .............. location Of Property ..... /?'-~.~ .............................................................................................. Owner Or Owners Of Property ..~...~....~....~~. ..... ~ .................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No....~...~..~...~.....~ate Of Permit .~.~./.~.~pplican* .~ ...... ~ .............. Health Dept. Approval .................... ~ ....................... Labor Dept. Approval ................................................ Underwriters Approval .../.~./.../.~..../..~.~.. ................ Planning Board Approval ........................................ Eequest For Temporary Certificate ........................................ Fin~ Certificate ...~........ ................. Fee Submitted $ ~~ .................. Construction on above described building and permit meets all applicable codes and regulations. App I ica nt .~-~~...... ~ ................ .. ..................... Sworn to before me this ......... day af ..... ..... ......... or Notary Publ'c .... ~.~.. County S-587~46 LEROY GRAF:*F Ail dl,tances fo we~s pnd ce,spoo~s are by ~acaf~o~ from house owners and field observahons0 since most wefts and cess- pools are not wsible these &mens~ons connol be cerhfled. Una0thoflzed olterahon or addition to this survey is a wolation of section 72.09 of the New York State Edu~hon ~w Copte~ of ~his surv~ ~Cp nor bearing the ~d su~o~s ~eaJ or embossed se~l s~atl not be constdpred to ~e ,~.ot~ons md~cated ~ereon , ,~orcn~, ' ~ c t~o su~y I~ prepared, a~d on ht~e ccmpanY, ~.emmental agency and lending instttu1~on hereon, and to tl~e assignees of the lending mstdut~n. Guarant~ or cerhf~caho~s are not transferable te add~bo~ jmt~ ~b~uent owne~. SURVEY FOR WILLIAM L. ,~ FANNY E. WYCHE AT MA TTITUCK ~ TOWN OF SOUTHOLD ettldla~f~Ee ~7.~.~.T ~. ~'~+~ ~RC, ~, ~gz~ ~ ~.~ , ~ _ / .I APPROVED AS NOTED CCVc.~ ...... CF ANY KiND (.2 h I1