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FORK NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy.
No.Z7'Q .,: . . . . . Date D.QC . a.. . . . . . . ., 1976
THIS CERTIFIES-that,the building located at . 3/.S. Sage.`$lvd• ;'• • • . . • • . . Street
Map No:,:u Block No. . : . . . . .Lot No.. . . . ArsMkazdaq a Greenport N.i. ,
y e
conforms'substantially to the MRE
Bide
F` b Before. .Apr. 23.: 19.�7., pursuant to whic�i� Ropiupabcy
Z�1+Qla• . .
dated .•. . . . . . . . DeE. . .3'. 1976.-. 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 . mdustr ,al.:building...(1�r c .li7.s3'gY,&..Acc�:ssory : vodden: hoat: shed)
The certificate is issued toKowarA .&. D.orothg• .Zehner. .. . . . . . . . . . . . . .
owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health,Approval p.re- eXiSt• g-. .
UNDERWRITERS CERTIFICATE No. .pre".;;.ekis.ting. .
HOUSE NUMBER . . .17601 . . . . . . Street . . Sage•B1, vrd • • -Greenport •(Southold RFD)
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 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 .....Dec.......3.....1.976............
New Building ................ Addition ................ Old or Pre-existing Building .X ...... Vacant Land ............
Location Of Property .....5/S Sage Blvd (Formerly Sage Brick yard)
....................................................................................................................
Owner Or Owners Of Property Howard... Dorothy..Zeh.ner,,,,,,,,,,, .....................................
Subdivision ........X....................................................Lot No. ... Block No. House No.......1.760
Permit No. ....7Z........... Date Of Permit ...XX...........Applicant .... ..&..11„Z,�hzneT............................. ...
Health Dept. Approval ........pre............................Labor Dept. Approval .......N.R. .......................... ...
Underwriters Approval ..........�?..e
PP ...............................Planning Board Approval A.B..............................
Request For Temporary Certificate ........................................ Final Certificate ......XXX............................
Fee Submitted $ .5.00.........................
Construction on above described building and permit meets all applicable codes and regulations.
APPlicant_._�_'...fi/ .. . ... ... ...........................................
Sworn to before me this check 12/3/76
............3.. day of .......Dec 976 c/o z74o4
..... ............... (stamp or seal) Receipt 12251
Suf folk
Notary Public ............ County
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