HomeMy WebLinkAboutZ-6502FO~ NO. ·
TOWN OF SOUTHOLD
BUll.DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at .. Hnoll..C. ir¢~k~ ........... Street
Bay ~st
,,_ r~qlASre.;nellts,,fQr,, on~ fa~:~ly .dwellJ~ng .& .~.ou~ng cod~
conforms substantially to ~ne
built ~.e x%lllfif, ate..oJ~ occunancy
dated .... Be£ore..Apr,..23., 19..57 pursuant to which Jfj~kr~o. z6~2. ·
dated ............. July...1.., 19..~, was issued, and conforms to all of the req~ire-
ments of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to . J. ohn. }t,. Schroecher ..... ~.~ner ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .P.r.e.-..e.x.i.~.t~D.§ .....................
UNDERWRITERS CERTIFICATE No. ~.e-.e~:istin~ .............................
HOUSE NUMBER ..... I. O.O. ....Street . .[ n oll. C iac 1 e ..... Z aa t. ['~ ~ iolx .......
...... ~ b. ~ ..... :lding/nspe r .....
FORM NO. $
TOWN OF $OUTHOLD
, 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, end submitted in DUPLICATE to the Building
Inspector with the following; for new buildings or new use:
]. 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. Dote 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 B~uilding .... ~ ..... Vacant Land ..............
Subdiv,~.~/~..~ ................ ~ Lot~N .o~. t:...~2~..f'..~,oc Block No ......................... House No
Permit No ..................... Date Of Permit .................... Applicant ..................................................................
Health Dept. Approval '" 'J~/'"/~'"'""~"~/~ ~-~ ,..~_L.--- ......... Labor Dept. Approve, ................ -- --'/~'""~'~'~"-7"
Underwriters Approval ..... ~.,~,..~,....~.~.... Planning Board Approval ........... ¢f~.,,../....~T~... ............
Request For Temporary Certificate ........................................ FinaJ Certificate ..........................................
Fee Submitted $ ~...~.... ........................
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