HomeMy WebLinkAboutZ-7499 FORM NO. 4 ;
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.'-Y.
Certificate Of Occupancy:
No :�� 9. . . . . Date
. ..THIS CERTIFIES Bare
.:that the.building located. at. E.;7S , :. . y Ave.: .-. .Street
Map;No x3c:, Block No XX' :Lot No, : . : QS�ra a 't » .
,.
con&iihs;substantially to,th r m Q e
i e 1-e ' f oeeu ancy
—da-te beQe; Apt 2 .: 19' :. ,pursuant."to whit, ,
R. No.
dated fan 2$ 19'` , 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 . .Ytivn;te:.0pe f-aw-.;Ly....V031i g..W; th.s eessory b a�. ng
The certificate is issued to . Robert .&. Susame. lalo3c ® ._ U ®rs
(owner, lessee or tenant)
of"the aforesaid.-building.
Suffolk County Department of Health Approval 1'� "" pX#. ing.
UNDERWRITERS CERTIFICATE No.. . .
HOUSE NUMBER 2 Street . .. �.�7 e y. . ve. eeA.n 4x' :
Building Inspector. :;
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
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 pe''Ainent 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 .... ...AT` 1271.
New Building Addition Old or Pre-existing Building ... Vacant Land ...............
Location Of Property ....xzy.......�e,67. .�,�...hA ..�)...71� r.... .Y.. � .. ..)I-T/... ►. ... .
Owner Or Owners Of Property ...(�Q
.e 44Pt .......AVdIMNA......
Subdivision ...............7-77.......................................Lot No. .....:...... Block No. 7=...... House No. .
Permit No. ..........Date Of Permit ...:"':....... :Applicant .. ..... ' ..............................................
Health Dept. Approval ......................Labor Dept. Approval
Underwriters Approval ................"':: .-....................Planning Board Approval .........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ..s7...... AO o...........
Construction on above described building and per ets If pplicable c and regulations.
Applicant ...... ......... . .. . .... .. ....... ...................... ...
Sworn to before me is 010 7—Hy
193 ?1
....�. ..day of .. .I .... I . .r..�./.7 .. IRV! (sCYJ
��mp o seal) (/`�`
.. L. PRICE;
(1� 10TARY PUBLIC, STATE OF NEW YERK
Notary Public ......... .. . . ..... ..K... County Residing in Suffolk Goo.a:timeof appointment +
My Commission Expires Mard 30, 1977
i
INSPECTORS
Victor Lessard
Principal Building Inspector �O�pSVfFO[�COG
Curtis Horton c y1 SCOTT L.HARRIS,Supervisor
Senior Building Inspector co z Southold Town Hall
Thomas Fisher W-
Building Inspector -
,f, • �� P.O.Box 1179,53095 Main Road
Gar Fish �1Q a0 Southold, New York 11971
Building Inspector Fax(516) 765-1823
Vincent R.Wieczorek Telephone(516) 765-1800
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
April 23 , 1993
Re: Suffolk County Tax Map #1000-34-4-11
Premises: #725 Bailey Avenue, Greenport, N.Y.
To Whom It May Concern:
Please be advised that the above premises are also known as
#514 Bailey Avenue, Greenport, New York.
Very truly y s,
SO THOLD TO UILDING DEPT.
-t °`�-�
Victo essard,
Principal Building Inspector
VL:gar