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HomeMy WebLinkAbout9157-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z89.1+.~ ..... Date . ,F,e.br.u.a.r.y..2? ............. ,19..7.8 THIS CERTIFIES that the building located at 3i 2. Rarad:l. ze. ~hQroz..[~l, Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . 14a. rch. 31 ........... , 19. ?~ pursuant to which Building Permit Bio..9.~.~.~.~. dated . I~l~.l, eh..31 ............ , 19..~.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...... P}~IVATE.. 0E~;..F~.~}4I.LY. I).I'(ELJLIi~.G. ................................. The certificate is issued to .. Er,. & .Ers.,..[lay~o~d..~.,..Aks.e.:[r~ ................... (owner, I(~%~K ~T~q~< of the aforesaid building. Suffolk County Department of Health Approval ...... ?~.s.O..-9~ ..................... UNDERWRITERS CERTIFICATE No ..... P.e..n.cl.i.n.§ ....... I~)66~]8~ ................. HOUSE NUMBER ,. ~12 ........ Street .... P. arack~.se. ~hore~ .~oad ............. .......................................... ~outk~ld,. ~,Y, ..................... Building Inspector FOEi~ NO. ~ TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISE$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9157 Z Permission is hereby granted to: R,,/a~. Aksc~n Build new one family dwelling at premises located at ...~.*..~.~.~.'.*'..~...~.../..~.~..P.~.~..~...~..~..8...e...~.~.~...~.?.~..~.~.~ ............................................. Southold pursuant to application dated ]/~l' 31 19...~.~.., and approved by the Building Inspector. Fee $ 30'1+0 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southnld, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructlons 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-9 form or equal). 3. Approval of electrical installation from Board of Fir~ 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 buiiding. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior ia April 1057), Non-conforming uses, or buildings and 'pre-ex'sting" 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 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 Z-- 2_~ New BHilding // Addition Old or Pre-existing Building Vacant Land Location Of Property ........... .~,/..~ ........ .~2.4~.~..,.~,,~,..~% ......... ..~..j.~,~.,e.,,.s. ....... ~'~1~. ...................................... Owner Or Owners Of Property ...Z~...~',_.?,......~...~S ........ ~4ty,~.ctr~..~.....~..~./9.....,/~....~.~:c...~..,'~.. ...................... Subdivision ................................................................ Lot No ............. Block No ............. House Nc~./..J..~:.,.. Permit No.....~./.~f.".~...... Date Of Permit .-?,2...]'.(.2...~.~Applicant ..... ~.......~...c.~....~ ............... Health Dept. Approval '?~..(..'~,/.~.~:....:?.,,,~:l).:...~,.c./~'.Labor Dept. Approval ................................................ Underwriters Approval .. ~.~.~Plannlng Board Approval ........................................ Request For Temporary Certificate ....................................... Final Certificate ......... ~. ........................ Fee Submitted $ ........::.~..:~ ............. Construction on above described building and permit meets al! applicable co(~s and regulations. Applicant ......... ~. K,~..~... .................... Sworn to before me this ................ day of ............................................ Notary Public .................................. County (stamp or seal)