HomeMy WebLinkAboutZ-5189 FORM NO. 4
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office i
Southold, N. Y. '
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Certificate Of Occupancy
No. ?5189 . . . . . . Date . . . ... . . . . . . . . 4une. . .13. . . . .. 19. 73
THIS CERTIFIES that the building located at .Mild.• Creek -Drive . . . . . . . . Street
Map No. fir' . . . . . . . Block No. . . . . . Lot No.XXX. . . Southold. . 14.Y.., . . . . . . . . .
conforms substantially to the ode
kffit. be ore ROM& A occupancy
Apr .....�3..._..,..,19.:.5? pursuant to which o.
z ,5T89 .
dated . . . . . . . ,June. . .13. . . . . .. 19 73 ., was issued; and conforms to all of the require-
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ments o the applicable provisions of the law..The occupancy for which this certificate is
issued is . . . .Private• •ore• family. 44elling • • • . . . . ... . . . . . • . . .
The c r ificate is issued to . Frank. & .A a. ,Leto. . . . . Oldness . . ! . . . . . . . . . . . . . . . . . . . . .
. 7 (owner, lessee or tenant)
of t e aforesaid building.
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Suffolk County Department of Health pproval pre. . existing. . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. . . . re, existiPg. . . . . . . . . , . .
. . . . . . . . . . . . . . . . . .
HOUSE INUMBER. .660. . . . . . . .Street. . . . .Mill. .Creek .Dr. . . . . . . . . .`.. . . . . . . . ... . . . . . . . . .
gxception to 'housing codes
1 . no light; switch at point �f entry 529b
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2.e Light fixtures wired with light
lamp cord; — porch, 2 bed '' oms, attic 528a gU;lding`,tnspector
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F'OBM NO. 4
TOWN OF SOUTHOLD
Building DePencn+eat i.
Town Clerks Office
Southold, N. Y. 11971 t
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APPLICATIOW FOR CERTIFICATE OF OCCUPANCY
InstMctious
A. This application must be filled in typewriter OR ink, and submitted in triplicate 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.
Date ......�/�/,/ .....................
New Building ..............,..... Old or Pre-existing Building ........ ...... Vacant Land
Location Of Property ............................../f.[1.�J.....(r. ..lC............//.... . .J....�............................
Owner Or Owners Of Property .........................ry-a.n..IL................`....erf...Ad......................................
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Su ivision ��. .. Q.f� Y.A (.IQ2.....Lot No. .. .. ... B ock�/No. ........... House No.............
Permit No. ...4114..... Date Of Permit l.X,l ..(.........Applicant ............../111T............ ..................
Health Dept. Approval .................ll.. . .............Labor Dept. Approval ............./..Kli.......................
Underwriters Approval ...............lK . ..................Planning Board Approval ...../ .01
Request For Temporary Certificate ........................................ Final Certificate X
/'`'...................... ..
Fee Submitted $ �Q.C?...................
Construction on above described building and per eets all opp able a and regulations.
Applicant ............ ... .. .....................
Sworn to before me //this
...All..... day of .Y..CtC.la.:e.......................... (stamp or seal) tle
S(
Notary Public .AJ.T. !2/.t........ County 71-1 ti -1,e�
LEFFERTS PAINE EDSON
NOTARY PUBLIC, State of New York
No. 52-1077685 - Suffolk County
Commission Expires March 30, 1975
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TOWN OF SO'IrIlO L 0,
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2� �°�' SUFFOLfC COUNTY, NY ,.
R yt'YED MAY ac, /973
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