HomeMy WebLinkAbout9353-z FORM NO. 2
TO~VN OF SOUTHOLD
BUILDING DEPARTMEHT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERt&IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FOLL
COMPLETION OF THE WORK AUTHORIZED)
N? 9353 Z
TOWN OF SOUTHOLD
Building Delm~tment
Town Glerk~ Office
$outhold, 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 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 disposgl--(S-9 form or equal).
3. Approval of electrical installer.on 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), 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 inspechon of buildings or prerr
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
3. Copy of certificate of occupancy $1.00
New Building .................... Old or Pre-existing Building .........,.~., ............... Vdcant
,ses, or other pertinent in-
$5.00
Date August: 3].~ ].977
Land ............................
Location Of Property ....~]~,~.~.U..~.O~,B.~..~,Q~.~......C~.I;~9~,~,~.,...~.^.~.,. ...............................................
Owner Or Owners Of Property ...... ~/;IC,,...~gt. TT~1C~..~AT, TX~g.~"~/~ ................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No ..... ~.~..~.~..~.... Date Of Permit 7./.~./..?,~ ...... Applicant ..... ...~1~..e...~......~..o.~.~..o.,,~.....~....8..,o..~..,8....~.~.....
Health Dept. Approval ..:~.~.....l~. .......................... Labor Dept. Approval ........ /~....[,~ .............................
. ........................
Underwriters Approval ..~. ................. t ....................... Planning Beard Approval
Request For Temporary Certificate ........................................ Final Certificate X
Fee Submitted $ ...5...t..O..O.. ........................
Construction on above descr.bed buildin~.~)~ permit me,~ ~1 ~pplic~able c~odes and regulations.
Applicant ..~,~. ~..~ ....~~ .......................................
of ~' ,':..4~, ..~.} 2 ~ (stem~ or sea~G~7/(-~4~/,