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Home My WebLink About9293-z ~OR~ ~O. 2 TOWN OF $OUTHOLD B~ILDIN~ D~:PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9293 Z Permission is hereby grant,ed to: by the Building Inspector ! ............... FOI~M NO. $ TOWN OF SOUTHOLD , B.ildlng Deportment Town Clerks Office 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 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 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 end "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 /~.;/~//o /...(../'~ .~.. Date ......... .4-.:.- ........................... New Building ................ Addition ................ ~OId or Pre-existin~l~uiJding ,~..~. .......... Vaconl~ Land ......... ~ ..... Locat,on Of Property.....`..r~.~)..~.:[.~.......~z~..~`'~..-..........].~..~..~.~r.....~..~.~.~;.` ....-.../~ [F'-:',.IO-~ ~{al~,. ~),~.,./9..~.~,~.~ ~. > (~.~...u..~.j,~.,,,~.. !.~....~...~..~:.~.~%~ O. rO* .................. Subdivision ................................................................ Lot No ........ JI.-.. Block N~ ....... ~.....~lou~e No ............ o, ............. Health Dept. Approval ../..~/.../..~r..f..Z ...................... Labor Dept. Approval ................................................ Underwriters Approval ....~'....~...?...~....~..~....~... ............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ......................................... Fee Submitted $ .....~........................~)-'~, ....... Construction on above described buil~permi~eet~ /app([cabl4cod~...e~es and regulations. App,icont ..................... Sworn 7~f. ore me th~_~/~._h ~ ~~,~,~1. .......... (. .... day of ...............(../~......J. .......... (stamp or SeQIJ/~/~/'~ ~*/~/~ ,, ,~ ,? ~': ;THE,,NEW yORK BOARD, OF FIRE' UNDERWRITERS . ,,:,, ~,,'Richa~d LaBlta, Naln-Bayvlew,~&~Clea~view West, Southo~d., h.I. inthefollo~nglo~d~ioa{ ' ~ N~e~nt , ~ hzM. ~'~nd'F~: outside was examined on, , 't September, ~25 - ~t .... be~compllan~wtthther~ulrementsofthisBoard, RXTURE '~ ';EP-Ai' S[ '' I-- 'E- ~ ..... FIXTURES ~ r '' ,"~ } ~ANGES [C~KINGDE{KSJ I OVENS JDISH WASHERS ~XHAUST' FANS DRYERS, J'~ FURNACE MOTORS ~ FUTURE AP~{~N~E FEE~ER$ S~E~ALREC'PT~ TIMECLOCKS [ BELL' ~UNITHEATER$ ~.~ .............. , . , ~; , ,~ .... ~ ......... ~ '. .~ ~ ,, · - ~SERVICE- DISCONNECT , ~ NO. OF [ , ' S E R V I C E I" Motor/s: 1-~2hp , , , ,, 1 G,F.I. '~ Detector ,. ' '- H ' ;~ '~, -" ' ' ' ' , ., : . ,r , , ,,:-t~':'~ lis cediflcate must not be altered in any manneo r~urn to the office of the ~ar if .ncorre~tj.lns~ctoq,~ay be identJied by s. This ced~flcat~ must not be altered in any manner~ r~rn to the offic of the ~ard :~tt ~$waga disposal and water Supply facilit£es for this location have been ill~peeted by this department and found ,to be satlsfaet~~__ ....................... {LEVATloN SCAL~ ©O'F ': VLk ll~ ICtt W I N b 0,~/ t-VT, )'z" F't'CWOOb ZU5 TL~. =- .. 4." I.~ L L"q Couu t.,',, t,I 4" P c. F~oo ~. -1 I~", ~' pc. 5 P E.,,NTI-~, -- 15~' ~LDC~ BA [CN --Yz" I(I T~. t..I ~ N '-., "I~ i lV l N G, % CL. ,1 ~,cL.