HomeMy WebLinkAbout9225-zBUtLD~G PERmiT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No. 9225 Z
pOrsuant to application¢ dated .................'-.~ ........ ~,...~ ............ i ....... 19.'?~:f,., and approved by the
Building Inspector.
Fee $ ........................
]PO]~M NO. 6
TOWN OF SOUTHOLD
Building Del~tment
Town Clerks 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 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 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 oJ property showing alt 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. 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 ~7~,-':22.. /.~.?..~....
New Building .. }.~ ..... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ...L2.~../..,~.L.~.?i.~.......~.'.,~?.~.~..X.-...~.~.~.(.~../.~....~..~....../~..~¢~,.~.~.~.~..~.~..~.~.~~?/~D
Owner Or Owners Of Property ....... ..~/..'.6..J?/...../~.. ......... .Z..:......~_~.....c}...~.....~./...~...~..~. .............................................
Subdivision ~.f.~.~,, ........ ~.;,~'. .................................. Lot No ...... ..~%.. Block No.....Z. ...... House No./..°.~.g.~
· . ...... · .. ..... '..'2... · .... ..... .......
Perm,t No ~./~ Date Of Perm,t ~,~..~/.2. Apphcant ~. /~., ... ~......~ ..
Health Dept. Approval ................. .'TZ; ...................... Labor Dept. Approval ................................................
Underwriters Approval ..................... 'Z~...:; .................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate
Fee Submitted $ ......~,.~,~',,,~,,.~,{ ...............
Construction on above described building and (p~/~ets all
App,,ca.t .......... ......... ................
Sworn to~efore me this //
.....~.~....~... day of ..,~.z..:....../...~...~..~.. ........ (stomp or seal)
Notary Publ~ ....~-Z,~.~.4,~ ........ County ~.
<~ ~ ,;x"IAPOF P~O PE~T",r,'
- ' .',¢,./m I L
~ ~ / ~AYV~EW
~~ ~-~ --.,~' TOWN OF
~ "xN k~:4~,~8~ 5,~,
GUA~NTEED TO
:: AS SM~E~ED JU~,27
' " 20P~RiEZ VAN TUYL ,~C.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~ ~ BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
the following locat~on~ ~. Bas~me~t- ~ 1st FL ~ 2nd Ft. 0 ~ ~ ~ ~ ~ Section Bl~l~ Lot
in g/,~n~ 5~ ],q~ andfoundtobelneompliance~iththe~equlrementsofthlsB°ard'
FIX;uEEs
DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIMECLOCKS NIT HEATERS MULTI.OUTLET
SYSTEMS
NO, OF FEET
DIMMERS
SERVICE DISCONNECT S E R V I C
(s~i~.,ing Pool) This certi£icate covers co~pliance at, the date of
inspection ouly, Dec,use of unusual environ~ents it is advisable
rep~ ~ ~ade by a.
to have frequent ~est and/Or . , qualified person,
Town Haroor Lane *~,~ ~R~ ..o~'..,~'~,.~,~.~,/ ~
This ce.lflcote must not be altered in any manner ret~ the ~,~e~~[~
COPY FOR BUILDING D~PARTMENT, THIS COPY OF C[RTIFICAT~ M~ST NOT BE ALTEEED IN ANY MANNER.