HomeMy WebLinkAbout9326-z FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH*OLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
9326 Z
Permission is hereby granted to:
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pu~uant to application dated .................... ;...~ ......... ~ .........19~..., and appmv~ by th~ ~ ',,JZ:.*~
Building Inspector. - ...... ~'~; ~' ' ~'~- ~
TOWN OF $OUTHOLD
Building Deportment
Town Glerk~ Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be fdled 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. F~nal 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 buddings, Industrial buildings, Mulhple Residences and similar buildings and
installations, a certificate of Code compliance from the Architect ar Engineer responsible for
the building.
5. Submit Planmng 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 hnes, 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, ar other pertinent in-
formation required to prepare a certificate.
C. Fees:
J. Certificate of occupancy $5.00
2. Certihcate of occupancy on pre-existing dwelhng or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ................................................
New Building . .~.!.~. ............ Old or Pre-exmting Building ............................ Vacant Land ............................
Sul:~ivision x';...: ........................................................... LO, No. Z.~.. ..... Block N'o ............. House
Permit No. ~...~..~....~.... Date Of Permit Z.Applicant .................... k .............................................
Underwriters Approval I~ann,ng Board Approval .....~..;
Request For Temporary Certificate ........................................ Final Certificat~
Fee Submitted $ .......~. ........................... j
Construction on above described building and permit meets all applicable Codes and regulations.
~Applicant . ,,..~.~.~ ~..:~ ..... ~...~;2~..(~.~. (~ .~. ........ : ..........................
Sworn to ~re me this / , ~~
................ da~,.~ ................................ (stamp or seal) [ ~1 '~: