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HomeMy WebLinkAbout9279-z· OI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 'Z778'8 ..... Date ........... July .... 2~ ..... , 19.7'7 THIS CERTIFIES that the building located at · .De]?~__r- Dr~$ve .......... Street Map No. Lau~ Cty 'Es~°ck No ....... Lot No.. ~3 ..... Aauret. · ~','~ ~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Jtlne ' 1 , 19 '97' pursuant to which Building Permit No .... 9279Z dated ...... J13~ '2' ' "19.~/?, 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 · PTlVDle on~ 'fanil¥' d%~elling' %;lth -addition ................... The certificate is issued to · Joseph Qutnfcan .... Owner ......................... (owner, lessee Or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. l;...'.q, ........................... UNDERWRITERS CERTIFICATE No... pending ............................ HOUSE NUMBER .... t000 .. Street .. Detma~- -Drive .... -Laurel. ............. ........ Building Inspector / FOI~M NO. ~ 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? 9279 Z Permission is hereby granted to: , Building Inspector. 'Fee $.t~,~ ........... I..of FO~ ~0. 6 TOWN OF SOUTHOLD , B.ildlng Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Inltructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fallowing; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topagraphic 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 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 $$.00 3. Copy of certificate of occupancy $1.00 .................. New Building ................ Addition ..~.. ........ Old or Pre-existing Building ................ Vacant Land .............. Subdivision ............................................. .~.~ ......... Lot No ............. Block No ............. Hou~ No ............ .... h .. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...~. .................................. Fee Submitted $ ..~..~....~...... .................. Construction above on described building and permit meets all_ applicable codes and regulations. Applicant~.~.:~/~~ ................................................... ~"~//"/?/~ Sworn to before me 1~ijs Notary Public .... -~--v-.-~-- (stamp or sea )