The URL can be used to link to this page

Home My WebLink About9355-z l~OE~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWFl CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9355 Z Permission is hereby granted to: ~-~ c~t premises located at .~..: ~..L...:.~~...~...~..~....~.- ~ ................................................................ ~..:.::~.~ ............ :. .................. ~~:.~....:....~..~~.~. .......... i ............................................... .[~**~u~uont to opphcmon~ted .......... ~ ................ ~ .~. ......... , 19 ., ~nd ~pproved by the ' BulldOg In~ector. ~ I~ORM NO. 8 TOWN OF SOUTHOLD Building Deportment Town Clerk~ Office Southold, 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 all buildings, ,property lines, streets, and unusual natural or topographic features. 2. F~nal 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 installations, a cert,ficate of Code compliance from the Architect or Engineer responsible for the building. $. 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. ,~ccurate 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 I..~....I ....-T....?.....7.. ............ n New Elulldl g .................... Old or Pre-existing Building ........................... V~acant Land ............................ Location Of Pro~ert· ~-I ~' ..~o~_~,,.~o~ I)Ce-- ~,~/~'~, ~'~..C~....~...L ..~.,~,,,- Owner Or Owners Of Property ...... ~...L~..?..~.,'~....~'7....~......-~./~'~.~?. ........... J ............................................... Subdivision ~.,.-~.~..~-,~..~..~.~,~......~. .......................... Lot No. Black o ............. House No ............. Permit No. Dote Of Permit .................... ^pp,cont .................. / Health Dept. Approval ............................................ Labor Dept. Approval ! ............................................... Underwriters Approval .............................................. Planning Board P~pr vol ........................................ Request For Temporary Certificate ........................................ Final Certificolte ........ ..~..)..~...../~._..~... ........... Fee Submitted * ................ p,cant ....... Sworn to before me this ~ ~ ~-// of MdT' / ?7/" day ~.]..~ ................... ~. ............. (stal np or seal) Notary Public ..... W~t:I~.t:.t*L~i~I~. Nota~ Publ~c, S~te of New York No. S2- ~250208, Suffolk C~mis~on ~p~r~ M~ 30, oo Unauthonzed alterahon or addaian tn that ~ecflan 7209 of lhe New York State Educahon Law C~ roes of th*s su~ey map not beanng Ihe ~ .~ or*embossed seal shaft not be cons~dered to be a va~d co ~ ~F:c~ or corhficahans re&coted he~eon shall run only to ~~ m cr ~hom the su~ey ~s prepared, and on his behalf to t ' ~ .~ e company, governmenlaJ agency and lending mshtuhon ~ hereon, and to the assign~s of the lending mshtuhon Gua~nt~ ;:bce~j~;zFtiZ;/e:[e no, ,~ns~erable to add,t,o~, ,n,t,tution, ~ ~ ~ ~ ~ c~X ~/ /~ ~c ~ //~ // ~ - REFERENCE ' SURVEY FOR ALFRED DAUDERT AT MATT/TUCK TOWN OF $OUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: I"= $0' JUNE I6, 1977 M/O ROSE WOOD E~_TA TE$ FILED JAIV, 24~ 1969 FILE NO. etlARANTEED~ HIGH NITRATES: ;~ater not to be used ~or prepa~ation of baby formula or consumption by ingants under 6 months of age. COX SURVEY FOR ALFRED DAUDERT ~ d)dYE J. DAUD£RT AT MATT/TUCK TOWN OF ,SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE ~ I"= $0' JUNE t6, 1977 JUI~E 27, 1977' ~UG, 30~ 1977 .NOV .'~0~ 1977 REFERENCE M/O ROSEWOOD ESTATES FILED JAN 24,1969 FILE NO. 5~40 'NOTED J d · i