HomeMy WebLinkAbout9332-zF~BM N~. 4
TOWN OF SOUTHOLD
BUH.BING DEPARTMENT
Town Clerk's Office
Southold, BI. Y.
Certificate Of Occupnncy
No..Z..-/.~./.~. Date ............. ~'f..P.7.... ?:..~., 19.77..
TI-nS CERTIFIES that the b~ding located at~. ?.~.. ~ .ZV. ~..~'..E... ~.~ .~..~. Street
Map No. ~' Block No. ~ . Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...,J ~ ~ .... ~ ~., 197.~. pursuant to which Building Permit No. ??..~..~..-f
dated ....... O.v.~X ..... 2.~.., 197.~., was issued, and conforms to ~! of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to ~.U.C E ..... .~..S.O..~ .~..-~ ............................
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval ~.~'P.'f..?'7.~. !
UNDERWRITERS CERTIFICATE No ........ .~.[. ?..~J..~/. (.~. ........................
HOUSE NUMBER ~. ~.~.~... Street .... .~..[..~..~. ! !..~ .... .t...~..x/..~. ..............
............................................. .C. ?..7. (. !~. p.e..~..~. ................
a,,~ ~e ~,.,,~ c ^ ~e ~,~',~ r Building inspector
FO~ NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
-TOWN GLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 9332 Z
Permission is hereby granted to:
..................... ~.*.!~..,.~. ...................................
to
pursuant to application aated ......
FORM NO. ~
TOWN OF SOUTHOLD
Building Deportment
Town Clerk. Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be hued 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. Final approval of Health Dept. of water supply and sewerage disposal--(S-0 form or equal).
3. Approval of electrical instal{arian from Board of Fire Underwriters.'
4. Commercial buddings, Industrial buildings, Mulhple Residences and similar buildings and
installahons, 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 ]957), 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 inspechon of buildings or prem~ises, 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
3. Copy of certificate of occupancy $1.00
$5.00;
New Building ....... ~ .... Old or Pre-existing Building ........................... VaCant Land ............................
,/,
Location Of Property ...~ ............................................................................ ¢ ........ ~...~...~ ......................
~ner Or ~ners Of Prope~ ..~.~.R..C.~. ....... ~.~.~.~.~. ..................... { ............................................
5u~ivision ................................................................ Lot No ............. Block N~ ............. House No .............
PermitNo. ~ ~Z DoteOf PermJt.~/~.~...Applicont ~,~/L~ ~Ja~ /~C
Health Dept. Approval ...~/~.~.~2.~ ...................... ~bor Dept. Approval ...~ ............................................
~e~/~ ~2 vi -' ~proval
Unde~riters Approval ............................................. an,,mg Board ' . .......................................
Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate /
Fee Submitted $ ........ ~.~.~ .................
Construct)on on above described building and permit meets all applic~able cbdes and regulations.
p,,cont ...........................................
Sworn to before me this
(stam~ or seal)
................ day of ............................................
Notary Public .................................... County
TOWN OF SOUTHOLD
Building Inspector's Office
Town Clerk Building
Southold, N, Y, 765-2660
N.55 52 30 E.
W. 5tMCHtK
LONG
~vGL.
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW fORK STA~
~DUCATION LAW
C'OPIES OF THIS SURVEY MAP NOT
THE LAND SU?VEY..),~'S iNK b ~.
/'-AF' \k...._.
CUTCHOGUE
~ow~: OF ~UmOLq_~.X:
X
755.97