HomeMy WebLinkAboutZ-5413TOWN OF SOUTIiOLD
BUn.BINC, DF, PARTI~II~T
Town Clerk'. Otiiee
Soulhold, BI. Y.
Certificate Of Occupnncy
No.a~'brl ~ ....... Date ...........Atlg~;...3It ..... , 19...----~
THIS CERTIFIES that ~e b~g loca~ at ~t/~.. filark .Road ......... S~t
Map No.. ~ ........ BI~ No..~ ....... ~t No ....~ ....S o~oli .. ~, ~ e .......
co~o~s su~.~y to ~e ~ ~~
~. ~.~?..~.~ .~.., ~.~. p~u~t to w~h ~~.~. ~.~. --~
dat~ ....... a~S~....~..., 19. ~, was i~u~, ~d co~o~s ~ ~ of ~e ~
ments of ~e app~cable pro~sio~ ~ ~e law. The ~cup~ for wM& ~ ~i~ h
~su~ ~ . }rSva t~ .~m~..l:a~:l~y. d~$11ing .......................................
The c~ffica~ h ~ ~..C~a~lea ~c~r.. ~e~. ............................
(o~, le~ or ~t)
of ~e ~ores~d b~Si~g.
S~o~ Co~ty Dep~ent of He~ Approv~ .prs~. e~st~ ...................
U~IT~S C~T~ICA~ No. ~r~s~ ..............................
HOUSE ~BER ... ~ 9.~ ....... S~eet ...Clark .2o~ ...........................
uildmg nspector ~
~OR~! NO. 6
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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-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 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
3. Copy of certificate of eccupancy $1.00
$5.00
........... ......
New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ....................................................................................................................................
Owner Or Owners Of Property ..... ~./¢..,~..~..~.~.......¥......~;.. ........... ~....~........~..~....~.....~..~:...i ........................
Subdivision ................................................................ Lot No....~.. · ...... Block No ......~. ...... House No....~..~..~T
Permit No ..................... Date Of Permit .................... Applicant .................. ~ ...........................................
Health ~pt. Approval ....... ~ ................................ Labor ~pt. Approval .......... ~ .................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Tempora~Certificate~.~ ..... ~ ................................ Final Certificate ........... ..~.. ...........................
Fee Submitted $ ...~.....~ .....................
Construction on above described building and permit meets all/~l~plicoble codes and regulations.
Applicant ...... ~..~.....~ .................................
Sworn t~o _~efore me this
of
N ora ry ~. ~.~,~.C,~ounty
Notary Public, state of New York
No. 52-0344963 Suffolk County, S'
Commission Expires March 30, 19~
(stamp or seal)