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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