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HomeMy WebLinkAboutZ-7355FOB,M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy Nap No ....... ~..~.... ~lock No .... ~.~..~ot No .... Y. ~ ...... ~... conforms substantially to the A~plieation fo~ B~lding Pcrmit hcrc~fore f' ~~..~ .... , lg.~. pursuan, dated ......... ~ ~ .... , 19.~., was issued, ~d confo~s to ~ of ~e req, lrm ments of the applicable provisions of the law. The occupancy for which this certificate is ,ssued is .... ~ .............. .~....(.[--~....-.~. .......................... The certificate is issued to .~...~'...~.....'~....'"~....'~......~.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~..~..~~( ................. UNDERWRITERS CERTIFICATE No.. ~ .~.....~'~.'. :~ ................... HOUSE NUMBER ...... ~P... Street .... .~.~ ..~..... f-..~ .......... FOR~ NO. 6 TOWN OF $OUTHOLD 0 Building Deportment 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 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: ]. 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 Bqilding ................ Addition ................ Old or Pre-existing Building ..... ~ ...... Vacant Land .............. · o ,on o, ' -- ............................... .................. Subdivision ................................................................ Lot No .....~Block No ............. House N0. ............ Permit No ..................... Date O~Permit .................... Applicant ...... .~....'~...~..........~....~'~ .... Health Dept. Approval ........ . .~.~. ............................... Labor Dept. Approval ................~......~.. ...................... Underwriters Approval ......... .~...~ ...................Planning Board Approval /~/~' Request For Tempora~rtificate ........................................Final Certificate .....~ ............................. Fee Submitted $ .,~ ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~~.~/,~ ....................................... ~4e7" 7-~ ~'--~' Sworn to before me this / ..... dayof .............. : ............................ (stamp or seal) ,,,,,c ou,, FLOYD F. KING, JR, Notary Public State of New York No. 52-7267800 Sufi%Jk County Term Expires/?,arch 30, 197~