HomeMy WebLinkAboutZ-5835 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.Z.583 5 . . . . . . Date . . . . . . . . . . . . . .Yjar. . . . . 2.6 . . ., 19.74.
THIS CERTIFIES that the building located atN•/S. . Ivlain. Road. . . . . . . . . . . . Street
Map No. Xx. . . . . . . . . . Block No.ZZ. . . . . . . .Lot No.=x. . . .Southold. . .N.Y... . . . . . . . . .
fess onof bit f�
conforms substantially to the `l :� s
bialpet before April 23 C '' e . fl occv. anc
19. 57. pursuant to whichN.4', � rl, G 583.5. . �
dated . . . . . . . . Mar. . .26. . . . . .. 19 71+-, 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 .I3usry xic.s.s .buildiri.g .-_ pr,offs p gna].. .Of f'ice
The certificate is issued to -Dr. .Armand.Roase. & .wifa . . . . owners. . . . . . . . . . . . . . . . .
(owner, lessee or tenant)
of the aforesaid building.
r ,
Suffolk County
!Department of Health Approval pm-- existing . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. . . pre-- existing. . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . �4795. . . . . Street . . . Xain .Road . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . L: . . .. ..". . . . . . . . . . . . . . .
Building Ins ector
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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
instollations, 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 Fines, 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 ....... arch 2 5,, 19 7 4
New Building ................ Addition ................ Old or Pre-existing Building .....Xi...... Vacant Land ..............
Location Of Property ... P. d..... outhold„N;Colonial;E:Reran;. Wosoxa
Owner Or Owners Of Property ......Armand M. Rose & wife..... .
Subdivision ................................................................Lot No. ............ Block No. ............ House No..........:.:
PermitNo. ..................... Date Of Permit ....................Applicant .............................................:......................
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............Planning .Board Approval
Request For Temporary Certificate ........................................ Final Certificate ..............X.........................
Fee Submitted $ .5.00
Construction on above described 'building and permit meets all applicable codes and regulations.
Applicant . Swor Damoc s H ding Corporation
... �. ..... ........... .411� .............
Sworn to before me this By
Sec—Treas
25th ..do y of . .. ,March 19.74 (scam or seal) 4_�6 7 "
... .... p
..
Notary Public .... . .....t.4S/L `'
H M.ARCHER
Public,
Notary Public, State of New York � Z
Qualified in Suffolk 893 County
No.52-0089350 �
gQmmissign'Expires March ,, 19785