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Home My WebLink About9349-zFOBII~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z7993 ...... Date ......... 'Nov ....9 ..... , 19.7~ THIS CERTIFIES that the building located at . Mhipya. rd. Lane ........... Street Map No. ~. Block No.~t~. Lot No ....... ........... ax ' E~'~t~' M~/~iOtt' ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 'JUly' '~''" 19..77 pursuant to which Building Permit No...93br~Z dated ...... July" ~..., 19.~?, was issued, and confoms to ~11 of the requb'e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is 'Private' one' fsanity 'dweT]:ing' ~1%h' ad'd it iwn' &' ~lte~'at ior~ ...... The certificate is issued to --Conrad' Volln-skt. · ' Owne I- .... ~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' 'N ,R', ............................ UNDERWRITERS CERTIFICATE No..pend~t~g ................................... HOUSE NUMBER .... 1OF~' ' · Street.. Sh~pyaz-cU'an~ ...... [' 'E ;' E~tz.[bu ....... .... ...... ~spector] l~OE~[ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9349 Z Permission is hereby granted to: .......... ~..~...~rA~ .............................................. at premises located at ......~.~r.~...~l ....................................................................................... .............................................................................................. ' ....................................... t ...... 1:7::"~.~ pursuant to application dated .......................................... , 19. 0, and approved by the.~. Budding In~tor. Fee ..................... Building Inspector ,~, ~ ~:~ TOWN OF $OUTHOLD Buildin9 Department Town Clerks Office Southold, FI. 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 disposal--(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 installahons, a cerhficate 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 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: I 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 ~ Date . I ;. ( ....... Location Of Owner Or Owners Of Property ........ ~-~'.+e~.- / C/' /~:...~: ................................. Subdivision ............................................................... '-~ Lot No ......... ~ Block No/ ............I~use,~lo ......... Underwriters Approval U J I ~",i," Request For Temporary Certificate ........................................ Final Certificate .......................................... Construction on above described building an~J permit meets all applicable codes ond._l'egulations. Sworn to before me this 1~01~ NO. S TOWN OF $OUTHOLD Building Delm~tment Town Glerk~ Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate Iocahon 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-9 form or equal). 3. Approval of electrical ~nstallation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulbple 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 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. Dote 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 . New Building .................... ,,OI,d or Pre-existing Budding ........ ~,,-w ..... Va~:an~l~nd ............................ Owner Or Owners Of Property '...~..~..{~.. .......... ~...~ ....... ...~w~.../. ............................ Sulxlivision .......................................................... , ..... Lot No ............ /B~ock N, ...... Permit No.~...~../~..ZDate Of Permit..~.~...~..4Applicant . .~...~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all gpglicable Sworn to before me this ................ day of ............................................ odes and regulations. (stamp or seal) Notary Public .................................... County