HomeMy WebLinkAbout9110-z FORM NO, 3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
9110 Z
Permission is hereby granted to: Eugene Ct. Morton & Sons
............. ~,/..e.... g~_r. A .s. ~..o.f..e.r...9~..:~.. ~ ..................
............. ~./.a..B~.~he..~ri~e ...............................
Cutcho~...et ....... N. Y.
to ..~.onmC~.~kc.~...a...~ri~.mt ~...on~ .. £aml~Y.. ~e llin& ............................................................
at premises located at ..... .~/..~..~.bf~...~.i.V.~ ..................................................................................
Subdivision ,5.~I(' Shores - lot #1
pursuant to application dated ........... l~i~r.¢l~..~.,~t ....................... , 1c~.~....., and approved by the
Building Inspector.
Fee $.. ~...~.0. ............
TOWhi OF SOUTHOLD
, Building Department
Town Clerks Office
Southol~J, hi. 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
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 disP0sal--(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
installations, 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 1957), Nonconforming 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 inspection of buildings or premises, 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 $5.00
3. Copy of certificate of occupancy $1.00
Date l~ay 8, 1978
New Building ..... ~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ..... ..w./....s...,.]~..~...t~.......D~....~..~...e. ...........................................................................................
Owner Or Owners Of Property ...... C...h:.~.~..s.~..°.~.e...~....~.~..d;.!.?, ..........................................................................
Subdivision .......Sg.....p:.~.~...~..~..o.~.e..s.. .............................. Lot No...~. ....... Block No ............. House No .............
Permit No. 9110Z m~+. nf p.r~i+ 5/2~/~7 Annli~an+ E..q~ene G. Morton & Son Inc.
Health Dept. Approval ...................... ~. ................ Labor Dept. Approval ................................................
Underwriters Approval X ~ '~7 T/'~3 ~ Planning Board Approval
Request For Temporary Certificate ........................................ FinoJ Certificate ........~. .................................
Fee Submitted $ 5°00
Construction on above described building g~d Eermit meets qll applicable codes and regulations.
.............- - ....................................
Applicant
Sworn to before me this
................ day of ............................................
Notary Public .................................... County
(stamp or se_el,)
/i%
· ~- ~ ~eal or ernbo~ec ~a- .k 'ii rill ~¢~rlng ll~e land ~Urveyor"e n~ed
....... oe cone dered
-- ~ ~ .u~ . o c~m '-~ .~ . , o boa vahdcon~
~ ~ ~ ~./,.o. ~o~ vroom lh~ey is pre .... ' ,~, ~-an run only to the
~ ~ t,~e ~cm-I ..'~ p ....... and on his behalf to
~-/ ~/ /-~c, 'X ~
~ -- ~ ~ ~ ~ / / ~ ~ ~ tem~ for thls residence will conform to tha
SUFFOLK COUNTY DEP~RTt~NT O~ ~ALTH S~VICESI[
FOR APPROV,.L OF CONSTRUbTION ONlY ',~~1 ~1 ~ I
- : ~ / ~t '1" '' ....
~u~. ,,, ,gr~ ~ S~ol~ ~,Y. I/~ ~ ~.
0
~ ~ APPROVED AS NOTED
Z ~' pErMIT iNCLUDES APPROVAL 7,:5-2560 9~M to 4PM FOE
~ '] TO EEMO~E EXCESS FILL - ~Sp~CTIONS:
FOR-'
SHT. I OF 2.
MODEL 'NO.
REVISIONS
AREA ,
~:~~,, .=~.,.~./ ~ ~ MKT. NAME APPROVAL