HomeMy WebLinkAbout9336-z FORI~ 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)
N.° 9336 Z
located at'.;
· ~1~'~', .'.,~ .......... , I9~..., and approved by the
FO~M NO. 6
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector w~th 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 disposalJ (S-9 form or equal).
3. Approval of electrical installatmn from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and
installations, a certtficate 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 buddings 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. Certihcate of occupancy $5.00
2. Certihcate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00 _
J uare ............. ~ ...............................
New Building .................... Old or Pre-~existing Budding ............................ V~acant Land ...... . ......... ~....~...~
~ner Or ~ners Of Prope~y .~.~.~.../.; ...... ~~ .......... ~ ........ : ............
Underwriters'Approval ~.~.::.:::.:::::::::Planning B:ard
Request For Zempora~ Ce~ificate ........................................ Final Ce~ificate
Fee Submiffed $ ~ ~
Construction on above described building and p~meets all a~l[c~e c~es,~nd regulati~s.
............. ....................
Sworn to before met~ ~~~ "'~ ' ' ' "'~~ ~ ~' /"
......... ...... ...... /
II~ORMATION FOR BUILDIN, G DEPARTMENT
THE PROCESS OF ISSI~G A CERTIFICATE
OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION
AS COVERED IN AN APPLICATION FILED~WITH OUR
DISTRICT OFFICE.
BOARD '~E ND~ WRITERS
CERTIFI CATE ~qO. NA
NEW YORK STATE DEPARTMEN'I OF HEALTH
ALBANY
CERTIFICATE OF APPROVAL OF SERVICE FOOD ESTABLISHMENT
CONSTRUCTION, ALTERATION OR REMODELING OF A
SERVICE FOOD ESTABLISHMENT
Thzs approval i~ xssued under the provisions of Part 14, Section 1~.12 of the N.Y. State
Sanitary Code.
1. Applicant
]Basil Tad D'emo
2. Location of Service
Food Facility:
Out of Joint
Main Road, Cutchogue
3. County:
Suffolk
4. Health Unzt
or Dxstrlct:
Eastern -
Food & Milk
Section
Type of Servzce Food Facilxty:
[] (2)
~ (3)
REMARKS:
New Structure ~
Remodeled Existing Service Food Facility
Building Converted from Other Use to Food Service
By constructin~ or remodeling, the applicant accepts and agrees to
with the following:
Form No.
GEN 18
THAT the proposed service food facility be constructed in
with the plans and specifications approved this day or ay
thereto.
PROVISION:
July 20, 1977
Date
abide by and conform
complete conformity
)roved amendments
Permit will limit operation to bar drinks and~Stewart sandwiches,
i.e. no food preparation due to lack of greas~ trap and need for
additional septic tank area.
Designated Replresentative
Ernst D~nda, Senior S~nitar~an
Suffolk County Department of Health Services
Name and Titl~ (prxnt)
3 to"o
C/-I. IO'
CH,/~'-
t<
$7",4GGEA £z~
?u~ CLIT'c No~z
S Ho PP/d® Cf/