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HomeMy WebLinkAboutZ-4803T()~XN OF SOUTttOI,D BUILDIN(; DEPARTMENT Town Clerk's Office Soulhohl, N. Y. Certificate Of Occupancy No. ~'~¢~03 .... Date ....... $e. pt 0 , 19.72 THIS CERTIFIES that the building located at R,.CloW o,...N~. 14alii. S~. Street Map No.. ~ Block No ~ ..... Lot No. ~ ..~o~thold. N.X. ..... conforms substantially to the ~ i ~ n e ~ ~ il ~ . . ~ before ~~ccupaney ..... ApriI '23' 19 ~7 pursuant to which Z~'~0~' ' dated ..... Sept.. 8 .... , 19.72, 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 .one..family. dwelling ................................... The certificate is issued to .~eo~.ge. $. Edna. ~idg~ ..... ~ers ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .7.re,s~;~tSr. g .................... UNI)} RWRI'II I~S (11411FI('ATI No.. pre-exiating ............................... ]IOUSI NUMBIR.~ ..... Strcc~ ....~.~a~e.R~. ~2 .......................... I~OB~ NO. S TOWN OF SOUTHOLD Building Department 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 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 unusua~ natural or topographic features. 2. Fina~ approval of Health Dept. of water supply and sewerage dispcsal--(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 ^pri~ 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 occupancy $1.00 $5.00 New Building .................... Old or Pre-existing Building ....... ~..~..~Z.. Vacant Land ............................ Location Of Property .....~..'..~..:..~.:......~./..~......~.....~.~....~~.....~.?.. Owner Or Owners Of Property ~ ~/,~{Z_ (~,~., Subdivision ................................................................ Lot No ............. Block, No.......~,.... House No ............. Permit No ......~ .........Date Of Permit ../...~.~....7. ...... Applicant ~~ ................ Health Dept. Appi'oval ........ ~ ............................... Labor Dept. Approval ..~...'J~' Underwriters Approval .............................................. Planning Board Approval ~ '1~' Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ~' ~ Construction on above described building and ~rmit meets c!! cRplicable codes and regulations App cant ......................................................... Sworn to before me this ............ . .~,, day of ..~:.....~..?...?...~... (stamp or seal) Notary Public .................................... County