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HomeMy WebLinkAbout9134-z FORM NO. 2 BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 913 Z Permission is hereby granted to: .................. £o~;~:1,c~ .......................................... to ...[~J.,.~,..~,~l~t&t, J.~.n...ozt.. e~c~_s~:Jz~8., xl.~el3,~ ...................................................................... at premises located et ..~...~..~.....~j..~..~..~..g~......c..e...~.~..~....~.~.~.~...~.~..~.~1~.~. ...................................... ............................................... ~/..8 ...C. ed~r... ~:~ ~,.. ~ ~ ~. ~)~. ......... ,8o~th~14 ............................. pursuant to application dated .................. ~¢,~.......2~. .................... , 19..~.~.., and approved by the Building Inspector. Building Inspector FO~ NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, FI. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAFICY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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 disposal--(S-g form or equal). 3. Approval of electrical installation from Beard 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 lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and cor~Jition of buildings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent 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 BLlilding ................ Addition ....... ..~...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................,~...~.......~....~.~,~r..~....../~..~/~,/~..~. ......................... .~..: ...................................... Owner Or Owners Of Property ............ ~....:L~..~.~.~.~'.~.....~..~./...,cz~...?.~.. ................................................ Subdivision .~'.~..~.'.~..~....~..~C....'~.........~..~¢,'~. ............ Lot No.../-/.:~.I. Block No ............. House No ............. Permit No...~../.~..~...~....~ ' Date Of Permit~..../~.....~..'.~..~..Applicant ...~..~././,~.../..~.-.~..~..~ ................... Health Dept. Approval ............. ~..//..~.. ..................... Labor Dept. Approval ....... ...,~/../..~.. ............................... Underwriters Approval .............................................. Planning Board Approval .... /..'.:. ................. ~ ....... Request For Temporary Certificate ......... ~./~.~. ..................... Fino, I Certificate ~ Fee Submitted $ ...... . .~)..~.!(~ .................... Construction on above described building and permit meets all applicable codes and regulations, Sworn tobeforemethis ~~~ ~/7,(/,~ ~-~T~, ......... day or ............ Notary Public ..... (stamp or seal)