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HomeMy WebLinkAboutZ-7784FOB,~ NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z.??.8.~. ..... Date ...... .......... JUly.. 21..., 19..~.7 THIS CERTIFIES that the building located at ...I%/$..P. econic. 2~y. Blv. d. Street Map No. Lan~:el. p~c. Block No ........... Lot No. 20.. Laurel.,..No¥., ............. reaulre~,ts ~o.r..ona. family dw~_l_l Lua ....... ce r. tific~t~_~. 0ceuoaney bu~latted . before. Apr. 2~ ..... , 19.57. pursuant to which dated ........... July... 2.~..., 1977.., 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 . Pr&rate..o~e..f. amit-y .~w~tting-. ~ith-aeee,sor¥..gara-ge ........... The certificate is issued to .C. hri.~topher..G~ttsch .~[~,.0wner ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .pre.--..axis.ting .................... UNDERWRITERS CERTIFICATE No..pre.-exist~ug ............................. HOUSE NUMBER .... ~ 82~. ..... Street . Gr....Peconic. t~y.. Blvd ..... L~u~el .... ~.0:~ .:. Full. hath..to, be..completer~ .......................................... Building Inspector FOB~S NO. 6 TOWN OF SOUTHOLD 0 Bulidin9 Department Town Clerks Office So#thold, N. Y. 1197] APPUGATION 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 disposalw(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 19.57), 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 in. spection of buildings or premises, or other pertinent formation required to prepare a certiticate. 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 :$1.00 ~ .' , -- ~ ..... New B~ d ng ................ ~Addition ................ O d or Pr~e-.existir/g B~/ilding ...... tr/.. ...... yac~nt La~ '"¥~'&7.'~' Location Of Property ....~..~?.. ....... ' ...... ~.,~.-t~..~Ol~"~.'Tet'2f ......'~'~-': ..... '~ 'l~r~':'7'~'/'~p'"~',~'~?'/' ......... Owner Or Owners Of p~:~rt~9~..~.....~.4~C%~.. .........................~'~- ............................ ?'"'~"~' ......... '~. ..... Subdivision ................................................................ Lot No ............. Block No ............. House No..(i..~...Z...$- Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... ~ ---' Fee Submitted $ ................................... described building and perr~jt meets aJjxapplic~ole codes~nd regulations. Construction on above , ,. ~ ~,/, ~..~ ~r~-~ ~.... ................................ ,,pp,,cant ......... ......... .,..' .................. ;m'7,7', 57Z7 Sworn to me~is before ~~'~"'~'~ ~ c-]~' Notary Public ....