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HomeMy WebLinkAbout9080-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z. ?.7..6.6. ......... Date ...... ~.o.v.e..m.~.e?.. ,27 .............. 19.7.9. THIS CERTIFIES that the building ................................................ Location of Property ... 5.80... South Lane East Morlon~ N.Y. tqouse No. ' ................... 'S't/e3i ...................... h~/nt'ei County Tax Map No. 1000 Section .... ~8 ..... Block .... 6. ......... Lot .... 9. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...l~o¥.e!alber. ~6. .... ,197.6. pursuant to which Building Permit No .... .9.0..~.0.Z ............ dated .. lv[aroh..'1.0 ................ 19.7.7., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .'[':~. ...... .............. Rriv~te. O~e .Family. D~elling ................................. The certificate is issued to ........ T~hOrtl~S. ~eld. ~[:[th. lVl:[lll:ligaTl .... : ................ [owner~ of the aforesaid building. Suffolk County Department of Health Approval ........ 6.90..22 .... N 468878 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev 4/7g FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 9080 Z Dote ......................... ['¢Q-...~.g~ ....... .1.0. ........ Permission is hereby granted to; ~.~.o...r~....s....~..~..t.~..!f.~.a..n.. ......................... ........... 9..!.....?.r..~.n..c..~.o.~..~..v..e ............ ..H..e.~.],.e..t..~.. N,Z, 1 lY~? ~o ..r.~,u.,t..~....q.e.:~....o?...~,~t.z.~..~..z..~:.t..~ ..................................................................................... at premises located at ..... ./ ...... .Q.V,.~]0, ............................................................................................. .............................................. Eas. t..1,,~r, io~ ......... N.,.Y.~ .................................................................... pursuant to application doted .................. .~...O..V....,..,~.~ ..................... , 19..'Z..6..., and approved by the Building Inspector. Fee $.,.~.~.....0..~ .......... l~O~t~[ ~i'O, 6 TOWH OF SOUTHOI.D , Building Department Town Clerks Office So,thold, 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, 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 buitding. 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 ......... New B~iiding ...... ~ ...... Addition ................ aid or Pre-existing Building ................ Yacont Land .............. .5. Location·Of Property .... '........ ~..C-Z.. ... .~,.,~/~.-' .......... .~...~....' ~./.c~.~Z. ................. Owner Or O ners Of Prop; ......................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval ..~..-.~....~.:~.~..~,~.L..... ...... L.obor D~t. Approval ................................................ Underwriters Approval .~......~.~...~...~....~....~. .............. Planning Board Appro¥ol ........................................ Request For Temporo~ Ce~i{ic~te ........................................ Fin~ C~fflc~t~ ..... ~ .......................... Fe~ ~bmitted $ ..~ff..~ .................... Construction on above described building aqd permit meets all applicable c.ocles and regulations. Sworn to before me this / ~, P ~ ~//~ (~ , '/~ ~/// ///~ /, ................ day of ............................................ (stamp or seol) ~ ~ ~ ~ ~ / ~, , ~ ~, ~ ,., , DEPARTMENT OF HEALTH SERVICES · RE: 6.-S~22! - South L~ne~ least I,larion~ N, 'f. DAVID HARRIS, M.D., M.P.H. ICiOM. M I$$J O N E R Dear A recent check of our files indicates that this office has never issued a final approval for the above referenced job. Please be advised that it is illegal to occupy the building until the fol- .lowing paper¥~ork is submitted to this office and/or the following inspec- tion(s) are completed: ~t'lell Drillers Certificate .. ~l~'Jater Analysis n-~Cesspool Certification ~_~Final Surveys ~:~] -. / Should you have any questions, please feel free to contact this office. Very truly yours, cc: Town Building Department ©©