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HomeMy WebLinkAboutZ-8975F~B~ NO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupnncy No. Z897~ ....... Date ...Ap.r.i.1. ........ .6. ........., 19.7..~.. THIS CERTIFIES that the building located at . .Mon~auk. Av.e ............. Street Map No ............. Block No ........... Lot No .................................. the RF_~..I~~S F.O.R. . conforms substantially to ONE FAltlLY DI~LING BUILT BEFORE dated . A.trl'il ....... 23 ..... , 19.5?' pursuant to wh~ch~o. Z$975 · · dated . Ap~'±I ......... 6 ...... , 19713., 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 ..... I~!VATE. ONE. FAMILY..D~'~.LZR~I ................................... The certificate is issued to ...... Herbert. Ig, .&. Caro~L ~'....Lac!d ................... (owner, ~) of the aforesaid building. Suffolk County Department of Health Approval ........... .P~..e.-.~.s}.~n. 6 ........... UNDERWRITERS CERTIFICATE No .................... .Pr.e.-.i~..i.s.t.~..n.~. .......... HOUSE NUMBER Street Mon/auk Ave ................................................ F. i~.h.e.r~..I~..au, d.,. ~..~...Y.o~.g... · /, .~-.~-~/~t/"~-~ Building Inspector i~O~M' NO. 6 TOWlq OF ~OUTHOLD , Building Department 'Town C:lcrks Office Soui'hold, Iq. ¥. 11971 APPLIGATIOlq FOR CERTIFICATE OF OCC:UPANC:Y 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: I. 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 disposol--(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 1057), Non-conforming uses, or buildings and pre-ex,sting" 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 ~.~ Date ......~-~4~ .................. New B~ilding ................ Addition ..,. ............. Old or Pre-existing Building ~ Vacant" ..... ................ .............. Location Of Property (~t~t~'~ ~ ........................................................ Owner Or Owners Of Property ...~....~..~....~...~..j~..'~... ~ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate ZL Fee Submitted $...~....~...~,.. .......... ' ......................................... Construction on above described building and permit meets all applicable codes and regulations. pphcant ........ Sworn to before me this . 9/- /~ .- ................ day of ............................................ (stamp or seal) ~ ~-- Notary Public .................................... Coun