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Home My WebLink AboutZ-6892 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.' ,• Z689 Date. . ' 'Qb r ry:_2 ; 19. .?6 THIS;,CgRTIFIES that.the btuld rigjocated;;at, S,/S Orgo t Rot d Street Block No.. Lot No. tfil�gU :: n �r conforms substantially to the xe ®� be' icertificate" of :occupancy da a p , .. 23. , 19 5 . ,.pursuant.to which„ NOA689,2.1 dated• . . . . .,. . , ftburary.:. . .24", 19:'76, was issued, and -conforms to all of the require- ments of. .the;•applicable provisions of .the law. The occupancylor:which,.this certificate i.s issued is` : artn.:(sQr� e 'bu .2dg. The,certificate is issued.to .Alox h. shir.ley,•Zvio ski. to :FrPabk,.mcBrid0` . . . . . . (owner,;lessee or tenant): of the aforesaid building. Suffolk County Department of Health Approval '•R*. . . . . . ... . . UNDERWRITERS CERTIFICATE "No.:p •,..e1.5 iu . . . . ... . . . . HOUSE NUMBER 11.750.;. .-. Street . . . . :Oreson. Raid. . . . . . . . . :. . . . . . . . . . . Building Inspector FORM NO. 6 " TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions i 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 $1.00 Date ...... ........... New Building ................ Addition ................ Old or Pre-existing Building ......X....... Vacant Land .............. Location Of Property ....,94$..QFZGQN..R0U .......................................... Owner Or Owners Of Property .........Alex..a&d...S]Z1r.bey.....Zuhoski ........................................................ Subdivision ............................................. ...............Lot No. ............ Block No. ............ House No............. Permit No. .................... Date Of Permit ...................:Applicant .....ti.0baxA..k: ......................... HealthDept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......X................................ Fee Submitted ......................... Construction on above described building and pZitteets • ppl'/ codes and regulations. Applicant .... ..... `. ......................................... .................. Richard F. Lark a-3�7 6 Sworn to before me this ......1! tgkclay of .FWPriAarY.......U.6...... (stamp or seal) '01 u Notary Public ............Sutfo.Lk........ County MARY LOU DOR-OSKf k0TARY PU3LIG, Stato of Mew York 'Pfo. 52-70,1CII5II Suffk5ak County (G� CodrIlission Expires March 30, IW77 �O • �s , s 945 Cv 0 h;yti �ou,,� ROAD 239.31 p 'Wolf. N11°0gp00 a N 11009 10 103 ,�E 32 gg'44 �, p . a R N 70. 'Q ` 0 k,' oX 00 ti5- c s 6�6 h1 � a� (e5 so-- 5' pc F ro p p� ell, �o C/ 'jfoA f T 35� Sa NOTE S000 20 McBride - MONUMENT PLACED S E rJ i tvisioN: YOUNG & YOUNG FE8.10,1976 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W.YOUNG HOWARD W.YOUNG PROPESSIONAL ENGINEER AND LAND SURVEYOR UNAUTHORIZED ALTERATION OR ADDITIiON LAND SURVEYOR, N.Y.O. LIC. NO, 12040 N.Y.S. LIC. NO.40003 TO THIS SURVEY IS A VIOLATION OF SECTION 7209 Or T14C NEW YORK STATE SURVEY FOR: _ EDUCATIOAI LAW ALEX ZUHOSK/ �,___�� COCI:S OF TF;,S "7^V,y MF.,,NOr gEARIING SHIRLEY ZUHOSK/ E rl;F :D y:.;, SEAL OR /��.•C'�,..•1 W• YC;� ''._�S r'y AID•., 1 •.t ;t-7 rE COr;CIDERIED :C/V -,ice. �� r.•r-. .•�..nN ,�a,• ,r 4''/I d• C';;1' .; � -• 'L RUN AT GUARANTEED TO: i R , 4 IR ., ?, I'-h : .,,- ._^c` . , r ,..,.� .� .. , 1'1E SURVEY 1'�, `�lt� �� "1',., w i. l...FtALF 7O THE �• :\•,.L:.i. '+'i?,l AGE^ICY LIit;4r'' f' AND TOWN OF 1 :`:`" " 41 to T+,, c, • SOUTHOLD f G, :•,`; INSTI- T� NOT T.RAWFERASLE SUFFOLK CO., N.Y. BY �`' V° 1 _:�,, ,.-'A� �w+:L�u. {GNS OR SUB QWENi SCALE: „ , DATE: