HomeMy WebLinkAbout9256-zNO. 4
TOWN OF SOUTHOLD
BUH,DING DEPARTMENT
Town Clerk's Office
Soufl~old, N. Y.
Certificate Of Occupnncy
THIS CERTIFIES that the building located at . 4100. Track Ave .......... ~
Map No... 569.A..... Block No .......... Lot No ..... 6 ............................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ... May. 2.3. ....... , 19.. 7.7 pursuant to which Building Permit No...92~6Z
dated . . May .... 23 ......... , 19...7.7 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 ....... Gare~ge. kddit~.o.n .......................................
The certificate is issued to ....... I~.. &
of the aforesaid building.
Suffolk County Department of Health Approval
Willi_~. Ko.~zky ................
(owner,
UNDERWRITERS CERTIFICATE No ......................... N./R .................
HOUSE NUMBER · · 1 .~ 00 .... Street ......... Track .Ava .....................
................................................ Cmtchggua~ .~e~ .York .........
County Tax Map N,_~mber
1000-103-12-6
Building Inspector
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED) ,;,
Per,mission is hereby grant~l to:
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, 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 Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property w~th 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 installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed s~te plan requirements where applicable,
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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 informa-
tion required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
New Building .... .X. ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ........ ?.e.q~..~.~.~..A..c.~.e.s.:Tr.-.~?¥.~.c.~...A¥.e. .......... .C.~;g~p.~t~ .....
House No. Street Hamlet
Owner or Owners of Property ............ ~/~L,],],$ .R[n. ~(~-b,,~;~. ...............................
103 12 6
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Map No .... ~,~. ?./+. ...... Lot No ....... 6. .......
Permit No .... .9.2.~.~... Date of Permit . .5./..2.~/?.?Applicant .... .W?... ?..o.t;.z~.¥..&..w..~; ...........
Health Dept. Approval ....... .N/.~. ............. Labor Dept. Approval ....... ~./.R. .............
Underwriters Approval ....... ~/.~. ............. Planning Board Approval ...... .~./..t~ ............
X
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted$ 5°00
Construction on above described building and, p~rmit meets all applicable codes and regu lat~ons.
Applicant . , .~. ......... '..~. ........ ~. ~...~,. i/Z1 ................
TO~ OF SOUTI~IOLD
Building Inspector's Office
Town Clerk Building
Seuthold, N.Y. 765-2660