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HomeMy WebLinkAboutZ-6880FO'n.M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No..Z.6.8..8.0 ...... Date ........... Feb.,...g ......... , 19.7g, THIS CERTIFIES that the building located at B.,.0, ~,. F~/$. f.~akla~. Ave. Street Map No..Xx ......... Block No...xx ...... Lot NoXxx... $o.uth.ol.cl. ~..)~, ........ ......... r~eq~Ir~-:~ent~f~, one fe~nil_v A~re]l~ng.&.j~ou~j~.,~, code conforms suos~antm~y ~o ~ne~ , , , ,- .... ~ .... ~ built Ee2t~fi_cate Qf occu;.ancy dated . .bef. oce. ~r. 2~ .... , 19.~?. pursuant to which s~,i~dm~ po~,,~i* No. ~zob^ dated .......... F. ebo...~ .... , 1~6.., was issued, and conforms to all of the require- ments of the applicable provisions of the ]aw. The occupancy for wMch this certificate is issued is .P. ri.v. ate..one, f~u~ily..dwefCLing, with. a.c.c.e $~.o. ry. g.qr. age.~ .dC.ck ~. ~..pilings some chain 1Xuk fencing in rear yard, vost & rail fencing on waterfr:~ The certificate is issued to .Abram .Berti~ge-r .&. E.tane · 0-'~ulti.va~. owner~..Bullchead~J~g (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .pr.e-exist.lng ..................... UNDERWRITERS CERTIFICATE No...pre.-.exis.t.±ng ............................ HOUSE NUMBER . ~,~.~ ........ Street .. 0e, kl~ .i,¥e ........................... FO~.M NO. 6 TOWH OF $OUTHOLD , Building Department Town Clerks Office Southold, hi. 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 pertirmnt 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 /I New Bu,ld,ng Add,t,on Old or Pre ex,sting Bu,ld,~te ~:n~'L~: Owner Or Owners Of Property .............. ~.. Subdivision .........~ .................................................. Lot No......~.. ..... Block No...~','. ........ c'~-~ ~ House No..,~,,,~.~,.. ~ Permit No ......... ~ .......Date Of Permit .....'~:~... .......... AppI cant ~ ......... ..~ .............. Health Dept. Approval ..... ~..~...~.....'.......~...~ ....... Labor Dept. Approval Underwriters Approval ..................... ..../.. .................. Plonmg Board Approval .... ................................ Request For Temporary Certificate ........................................ Fincd Certificate Fee Submitted $ .....~.....~ .............. Construction on above described building and pe]'mit meets all applicable codes and regulations. Applicant ..,..~,~ ....... ~./~.~. ............ ~ ........................... Sworn to before me this .......... ;Z... day of ..... ~--..~::U. ,,'. ? .C ~. ..~. ........... (stamp or ~eal)' Notary Public ....~.~ounty /~/~C~- ~/~ //