HomeMy WebLinkAboutZ-5515 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z. >59 5. . . . . Date . . . . . . . . . . . Oct 10
THIS CERTIFIES that the building located at :F/$. pepot, Lane Street
Map No. X=. . . . . ... . .
Block No. . . . . . .Lot No. X=. . QUtchO9uG. . .N.Y. . . . . . . . .
e n s fo bu Ines buildin b t before
conforms substantially to the
Certificate of occupancy
. .April .23. . . . . . .. . . . .. 195.7 . pursuant to which WiH 92U0tWLKzO.Z .5. 5T5 .
dated . . . . . . . . .Oct _ . . 10 19 93 was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . . .Non-conforming (pre--existing) business building
The certificate is issued to Steve. Doroski to Joseph L *9vski Owner
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval p.T@"existing
UNDERWRITERS CERTIFICATE No. . .. . � . . . . . 411$
HOUSE NUMBER. . . . 2300. . . .Street. . . .Dep.ot .L=e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 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.
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 ...:..:Oc.ober;„aA. 197!.....
New Building .................... Old or Pre-existing Building ...X....................... Vacant Land ............................
Location Of Property .,...QU-tQ }.RJ.LZe.r:..NAW...X.Qx,K....................................:
OwnerOr Owners Of Property ..............................................................................
Subdivision ...................................:............................Lot No. ............ Block No. ............ 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 .....M................................
Fee Submitted $ ..5...0A.........................
Construction on above described building and p me t appl' I odes and regulations.
Applicant ...... ... ... . .............................. . .......................
ickham & 'Lark P.C. , .atty.. for Purchaser
Sworn to before me this
Joseph Lizews]'Ci
2nd..... day o ....o.ctc.ZbPx.,...19.7a....... Pq (stamp or seal) /�./_ 10 l f 73
Not Public . . ....ti....Su.ffalk..... County NOTARY gt�clvoEF�S^`cN
04011 red
"r Su olk Cc n
`eg
7 � I
i Li!
V LN
m °
CD
o t iznrnE I
31
f� UNAUTHO.,q .
I
u U C Z \"I s�_'! Ec AucaAr
TO r
THIS SU!t YEy,S A VIOLA T; F �1710N
O
SECT!Ol,1 7:09 , O�!
EDUCq TI " T;fE A-E V YORK STATE
I or•r LAW.
COP1G5 Cr,y;S "C
THE LA. k0
-
T u:AR!NG
- TO C; A S':1i!3 -`flC`,�.IE. `C.'' SIDE
P.ED
IhAP OF PRV P�i.,.. Rr 1 f/ ONLY
Sup—VEYED . FC}� >ftiLc r ..,:P,:e ;' O:i t.i' TJc y.
..�� `O T!fE
To
,."T,-
. ♦)i ��Q t S. f•�) OW AD:,,
S T.J'•:,i ji1'S71TUT!CnSt OF SU3SFQUEN7
NEW
{_1A2A;1I'EEh TJT��r {�.5, i.LI TITLE
o SUr:,Vi:;f b JuNr-.lo !�?'r .
0 = /AOW4J1AF.�iT r r '
VODEQ "- w" 1,�AN TLJ f r
CGc�E.',Np F NC='N YLLf7i�� ....