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HomeMy WebLinkAbout9087-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy THIS CERTIFIES that the building located at ............. ~?..~?.n.~.a.¥. }.~:s.~ Street Map No..~.n. :~.e.... Block No ........... ~.ot No.. ).'.. ~ .0.~.~?.n?.....~.,y.: ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ,.':,,:~:...~.3., 19 ?? pursuant to which Building Permit No. dated M:¢r 1.5 lg. ??, was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~.lvate one family dwelling with porch addition issued is ........................................................................ John T. Guer~iere The certificate is issued to ........................................................ (owner, lessee or tenant) of the aforesaid building. N.R. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No. HOUSE NUMBER ~%0 Street Oreenway ~ast Orient Building Inspeet~ · FORM NO. 2 TOWN OF SOUTHOLD BUILDliqG DEPARTMEiqT TOWN CLERK'S OFFICE SOUTHOLD, iq,. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9087 Z Permission is hereby granted to: ~..o,.~,, ...~.:...g.~.~.~ r.&a ..................................... ............ g.v. ~..~..n..v,..s. ~...~.~. ............ .o.r.~n~ .......... at premises located at ....~O.~...~. ......... g.l~.~,.e~..,~LgI',~s._~..Ol%~,~q~ .................................................. ......................................................... ~..e..n...w.~...~..s.~ .......... .0. ~.Le..~..% ............................................... pursuant to application dated ........................~].~......~.~ ............... , 19...~.;~., and approved by the Building Inspector. Fee $....~ .~..e .O.Q ......... Building Inspec~kor TOWN OF ~OUTHOLD , Building Depa~ment Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OC:GUPANC¥ Insfructlons 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 unusua~ 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 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ...... ................ New Bt~ilding ................ Addition ..... .~........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~'~e~....l(N~. ~./~...~.~.~.:~5-- *.- /~ -- ,-~'"'~'/"/~g'~'"'"l"~"~'/"'"d~?'4'-~'~'q~'~"~"~'~'~' Owner Or Owners Of Property .....~,..O,./(/(,/,~......./,...:....,.~.Z;~, ,~,.~'./.i~,x~. ................................................. Subdivision ...... .~..~...,..,~..~ ........................... Lot No. ~ ...... Block NO ............. House No....; ........ Permit No. .~'..~.'...~'..,?..... Dote Of Permit-;~.. ../..~..~Z.~,ZApplicant .~.~. ~- ~=,,~,~/ ;,,e~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate ....... ....~...~ ............................ Fee Submitted $ ...~.:...~ ................... Construction on above described building and per~it meets all applicable codes and regulations. Applicant .................................... Sworn ,o before me this , ....~.,..~.. dayo~ ..........