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HomeMy WebLinkAbout9069-zFOI[M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O//ice $outhold, N. Y. Certificnte Of Occupnncy No. Z?~.~'2 ...... Date ............ Al~g. ].6. ........ , 19F.~.. THIS CERTIFIES that the building located at Bircl~ ~Lane ................ Street Map NoBlreh. HiilJ. s Block No ........... Lot No..15 ..... Cutchogue ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Fab.. 28, 19.7?. pursuant to which Building Permit No..90~,9,?,. dated .............~ar,~.....? ...... , 19. ?.2, 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 . 5'r. iva .i.e.. one..family, d~.e.1 ;~ lng ....................................... The certificate is issued toG,gy.n~e.,..C.o.l~8~;F.u,c.~,~)~ .qo:cp ....qy~.eT.-.b-aJ_J,~ler ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A~g...~.. J.9.??...by. B....¥J.]-la ...... UNDERWRITERS CERTIFICATE No...N'~.~'~I ~ ~ ..... .o']l~... 2.9. .. ] 927. ............. HOUSE NUMBER ..... :[.~5 ..... Street ...... B~.~.ch. Lane ....... C~ltch~.~ue ...... ...... ~ .. ~.~ ............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9069 Z Permission is hereby granted to: ~ .e....,q ,o.,,rt ~ ¢..: ....q ,o**,:~ ....................................... ....... j.~**~.....?!.o..~.~..~ .......... .~.~.~.~**o.~.. at premises located at ..~..O.~....'l.~........~.~..C..~....}..~.~..]:.]r..~. ............................................................................ ........................................... ~.t...:..c..~ ...~.e. .......... .c..u..~.e..~..~.g~ ............................................................... pursuant to ~pplication doted .......................... ,.~..e..~.......~.~ ............ , 19...~., and approved by the Building Inspector. tee sj.,o.,,o.:~..o. ......... FOBM NO. 6 TOWN OF SOUTHOLD Building Depar~mem Town Clerks Office $outheld, N. ¥. ]197! APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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 end 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 3. Copy of certificate of occupancy $1.00 $5.00 .. .......................... New Building ..,~. ............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ,..[..~..~......~./..~......~(~.......~/,~.'~.~L,~.~.(-~I~.......~... ............................. Owner Or Owners Of Property ~.~..M..~..~.....~1,.~..~ .~tJ~.~........~......~..,.~,./,~ ...... ~:...~..~:../¥~, Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.~.~.~t..~.,.Z=... Date Of Permit ~.l/.l~...Applicant (~f~.~.N,,,,~,~'~,,,,~.,.~J~ .~.~..~......~..~.....~. · Health Dept. Approval ?,l-~,/~,,~., ...... .Z'..~..~..?...~.~...Labor Dept. Approval ................................................ Underwriters Approval .'/.l..~. ~'"J..~........~....~.~.J.J..~..Planning Board Approval ........................................ Request For Temporar~ Certificate ........................................ Final Certificate ,,.,,X~,,, ............. Fee Submitted $ ~'~ ~"'~---~ ..................... Construction on above described building and permit meets !Il applicable codes and regulations. Sworn to before me this ....... /Z. day of ......'~..~..., .~...~...Z.Z ...... (s,amP or ,eo~'~~- ~'F~;'z¥' Notary Public ......~~~. County _i i ~ 9..77 .) ~727_5-' I, . '! 0 :1, '* L ,®.