HomeMy WebLinkAbout9344-z FOH~I NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFIC~E
SOUTHOLD, N.Y. '
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 934~1 Z Date ......................... ~,....~.: ..........
Permission is hereby granted to:
.... ~a~t~.~. ~a....~. ...................
................ ~ea~ee~..:~ ............ 8e~-~-~3~ ....... :v --~
to. J~.,t3,¢ .~e.~.. a~,~.e~x-'.~...£ I~:~e.e ~ ..~ ~e.~ .. ~:d, la~ ...................................................
FORM NO. 6
TOWN OF: SOUTHOLD
Buiid]ng Depar~rnen~
Town Hsll
$o,,thoid, N.¥o 11B71
AP, ~IC~ O ,J FOR v~RT,F1CATE OF OCCUPANCY
Jnstruo~clons
6LDG DEPT
TOWN OF SOU,'rH_OLD__,'':
Ao
Tn,; ;221icauon must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspe~
tor'."mn the follo,,wng, for new buddings or new use:
1. F:n;l :ur,'ey of property with accurate location of all buHdm§s, property lines, streets, and onus.
· "~;Jr&( or toccgraohic features
2. Fm;~ r:~aroval of Health L3eo~. o1' water suooIy and sewerage d~soosal--(S-9 form or equal).
3..~.c2¢ov31 al e!ectncal installation from Board of F~re Underwriters.
4. Commaro31 buildings, Industrial buifdmgs, Multiple Residences and similar buildings and insteti~
tions, a caruhcate of Code comphance from the Architect or Engineer responsible for the building
5. Suom¢. Pl;nmng Board approval of compieted s~te pian requirements where applicable.
For ex~stmg bui!dmgs (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing'
Jena uses.
1. Accurate suo~ey of peoperty showing ali prooerty lines, streets, buddings and unusual natural
tooo3r3or,~c Ceatures.
~. S~%o~n st3tBmeRt of owner or previous owfler as to usa, o0cuoaRoy ~d condition of buildings
3. Data of ~n,/ housing code or s~fety inspection of build,rigs or pnemises, o~ other pertinent informa
t~cn rcqu,red to prepare a Ce~tflC3~e. /~
Fees:
1. Coed;cate of occupancy $5 00
2. Ce~td,ca',~ of occuoancy on pre-existing dwelhng or rand use
3. Cos,,' of certificate of cccuoano/ $1,C0
,$5 oo
Ne:v Bui!d;r? ............ OJd or Pre-existing ~uiicmg(:¢) ...... I-: /Vacant Land ............
Ccun~,/Tax:,,l¢o No 1000Sec Jan .. ____ ...... Block .............. L~t ...............
Sue=k,~s~on ................................ Fded Map No ........... Lot No
Health Dap:. Approval ........................ Labor Dept. ApproVal .............. , ........ ,..
Under.'zruars Approval ........................ Planmng 5oard App
Request for Temporary CeLLLflcate ..................... Final Cartlfi
F~e Subm~t':d S . .~ ....... ]~../.~ .~ .........
Construct.on on above described budding and pern~t meets all aoohcablacod*s and regulations
royal .................. ,~ , . ~
:ate ........ - ......... -
oo
TO~VN OF $OUT~OLD
OFFICE OF BUILDING INSPECTOR '
P.O. BO}[ 728
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL. 765-I 8O2
.... bo a,._~e you ~,~ ~.h.e ~ob u .... r Buildzn~
Permz~ No. ~ l~su=d ~o
a ~zzal z~ ~ec~ion ~zs~'h~g nofz~ ~en ~one.
in orcer %o conD!eze thzs ~ile, z~ is nec,essary txaC
a CerczYzca~e o~ Occupanc7 be issue~. Piease .~i!l ouC One
enc!~se~ Yorz.(s), return same ~o ~e =~o.e o--I-C~ ~-~ a
check Pop $5.00 DayaDle ~o the Town oS Sou~nol Please
znczcate to whom the Certzfzcate of.Occupancy to be nailed,
an~ arrange with tnzs office fop an znspecSioa date,
Thank you for your prompt attention.
Very truly yours
Vic top Lessard
VL:ec
E~clo$u~es