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HomeMy WebLinkAbout9342-zNO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No...Z. ?.~..6.2 .... Date ............ Aug...30 ..... , 19~:/.. THIS CERTIFIES that the building located at . kine..T~'ee. ~oad .......... Street Map 1%1o. llas. sau. Fas Block No .... xx · · · Lot No, ~... C,u%ehogue .... }~ ,¥., ........ conforms substantially to the Application for Building Permit heretgfore filed in this office dated .......... (tulle. 29., 19.77. pursuant to which Bufldin~ Permit No..931~2Z. dated ............ .ff.u~!. e... ~), 19.7~., was issued, and conforms to all of the req~ire- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pri~ai;e. one. family .dwe.l. ling. w.l.~1~, addition. &..l~enc-i. ng .......... The certificate is issued to . LoueLs ~. -Bal'b.~a -LaG~,_a~d ..................... <owne , ess O 'tgn >o - of the aforesaid building. Suffolk County Department of Health Approval R~I~, ............................... UNDERWRITERS CERTIFICATE lq'o...p~nd~'Lng .............. , ................... HOUSE NUM[BER .1.60~. .... Street .. P~ue. Tr~0. Road ....... C~utehogue ..... Building [nspe~or FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (TI;tIS PERMIT MUST BE KEPT, ON THE PP, EMISES UNTIL FULL CQMPLEI'ION OF THE WOrK AUTHORIZED) N9 9342 Z Date ........................... .~r:lil~....~q~. ........ , 19.~.. Permission is hereby gron~ed to: , I..~..3.....~..~ ....... ]~.= ....~.*...:I~~. ............ ~ "' FORM NO. 6 TOWN OF SOUTHOLD Buildiag Department Town Clerks Office Soufhold, N. ¥. 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 with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property 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 instalJation from Bcx~rd 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), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, 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 prer~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 $5.00 3. Copy of certificate of occupancy $1.00 New Building Old or Pre-existing Building ............................................... Vacant Land ............................ Location Of Property ...~..4.~.~...~. ......... .~.....~....~?.....~'.. ........... .~...O...~....~....:/ ..... .~..~...~....C:..~,..~..~,...~ ................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval ......~.:...,.~. ............................. Labor Dept. Approval ...!....~.....J..~. ............................. Underwriters Approval .............................................. Planning Board Approv!l .... .~...'...',~. Request For Temporary Certificate ........................................ Final Certificate .......... ~ ................. Fee Submitted $ .................................... Notary Public .................................... County