HomeMy WebLinkAbout9327-z FORM NO. $
TOWN OF SOUTHOLD
Building Department
Town Hall
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 Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, prope, rty 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 installa-
tions, 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.
Bo
For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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 '~ondition of buildings.
3. Date of any housing code or safety inspection of buildings or premise,s, or other pertinent informa-
tion 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 Building ./../.O-2...~-~.... Old or Pre-existing Budding .... Vacant Land .
County Tax Map No. 1000Section ..7~) ......... Block ..... ? .... i''' Lot...~.~ ........
Subdivision ....................... .., ./.../...Map No ............ i'' Lot No ...............
Permit No.~'. ~.~... Dateof Permit ~.~J .~/?lApplicant("'~/~ .......... [ .......................
Health Dept. Approval .Labor Dept. Approval I
Underwriters Approval ........................ Planning Board Approval ......................
Request for.Temporary Certificate ..................... Final Certiflcat!
Fee Submitted $ ............................ i
Construction on above described budding and permit meets all applicable codes and regular OhS.
Applicant . ~ ...............