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HomeMy WebLinkAboutZ-7021FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z7.0.2.1. ...... Date .............. .HAY... .7 ......., 19.?.6. THIS CERTIFIES that the building located at .... . .I~a.y~..a.t.e..r.s..H.o..a.d. ...... Street Map No. Na$~.o.p.t..,..PBi~k No ........... Lot No, l).t...~.7. & 268 Cutehoi~. e NoY q renents for one conforms substantially to the ........ built before certif$cate of occupancy dated ......... .Ap.~..2..~ ...... , 19.5..7. pursuant to which ~~,~No. dated ......... l~laI... 7 ......., 19.~..6., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .~. ~.~9.n.C..H.e..:l~. 0ruler of record of the aforesaid building. (owner, lessee or tenant) Suffolk County Department of Health Approval P..l~.-.e.x~..8..t.~..g ...................... UNDERWRITERS CERTIFICATE No..I~U$-...e.~s.t.~.n.g ............................ HOUSE NUMBER ..... ?~. ...... Street ....H.a..yy..a.t.e.r..s..H.o.a..d ...................... N0..T~. ~..T.12~,$..C/.Q. ~.o.v. qr.~..t.h.e...~.i.n...b.l~..i .1.d.~..g..n.o.t...un..d.e.r...C/.0...~..~.7.0...f.o.r.. ,~1...addit. Building Inspector FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment 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 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ..~. ........ Vacant Land .............. Location Of Property .... ..~.~/.~.~...y..j:(~....~....~-..~'.~.~.....~.~..~......~. .......... Owner Or Owners Of Property ....... ~..,,~/./,~.~'.~, .~..,.....~.........~,,~,/..,,..,~.~, ................................................ Subdivision &(...~..~..-'~.'./. ......... Lot No..:~..~.8... Block No....."~. ....... House No....~.... Permit No ..................... Date Of Permit ..... ~ .............. Applicant Health Dept. Approval .... ./.Z/~.'~. ......................... Labor Dept. Approval .... ..,/Y(...~..Z..~. ............................ Underwriters Approval ....... ~.Z~2..'~..: ........................ Planning Board Approval .....~'.Zx.~..:./..,~..: ...................... Request For Temporary Certificate ........................................ Find Certificate ....... x~.' . ................ Fee Submitted $ .......... ';.....~' ................... Construction on above described building and~rmit meets all,~licable/cod~s and regulations. ,x'~ day of / ............................... ......................... Notary P~ JOHN L. MOLLOY ....... ~ ....... ;~ .... County ~"-~ ~' ~7 NOTARY PUBLIC, State of New Yerk ' No. 30-79~6500 Residing in Nassau County