HomeMy WebLinkAboutZ-9572 FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate. Of Occupancy
No. 9 S 7 P . . . . . . Date . . . . . . . . . . . . . . . . ,1U.N.E R 6. . ., M .
THIS CERTIFIES that the building . .p,- . • . . • . • • • • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •
Location of Property -,- . . . . . . . . . . . . . . . . . . . . . . . . . ._.. . . . . . . . . . . . F.15P.ff 1?.S. . .ZS Lm N b
House No. Street Hamlet
County Tax Map No. 1000 Section . . . . .I.0. . . . •Block . . . . . . . .�J. . . . . .Lot . . . . 13. . . . . . . . . .
Subdivision Ift-14.1 N-5V I.A. .P:r . F.ISN�&-S% . T: 1,PV Vlled Map No. Lot No. r p. �►. .�•1
h U tC'C( LN F ' AIE FRPI'� `S li -1L1 Cr .aU �.T t0 o
conforms substantially to the%,Rnr�,ratinn 1br • n] E P'prmjt _here "6re_�d�n thus c ice Tated
R-rNO Z
. . . . . . . . . . . �.�. .?3, 1957. pursuant tow hich Fib' -r :0. . . . . . . . c. . . . . .Z . .
dated . . . . . . . . . . . . . ..ju-m6 . . . . G • . 1977. ,was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is . .,q. . . . . .
. . . . . . . . . . . .....IF4V,A TI;. . . .�,NL. . . . A.N}F.J.-1 D(xbf{.-1.IfA6-. . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . :j3A.k.t;:( • • .qwu• Jb A.rK.I.1-v-N1. . . .'K•c)S M 13E h C9-. . . . . . . . . . . . .
Nr«, (owner,lesspa or ten n�J
of the aforesaid building.
Suffolk County Department of Health Approval .6 . . . . . . • • • • • • • • • •
UNDERWRITERS CERTIFICATE NO. . . Wr_ .. . . . . . . . . . . . . . . . . . . . . . . . . • • • • •
Building Inspector
Rev 4/79
3 —1 3
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 .....................
New Building ................ Addition ................ Old or Pre-existing Building .....x......... Vacant Land ..............
Location Of Property .Lots 5,0 and 51, map,entitled 'Plan............ .............................:.....
N. Y. , owned by Charles W. Hi'
e, filed in Suffolk o. Clerk's Office on 5/11/13, #223�
Owner Or Owners Of Property ....Kenneth C and,Irene A Ah gran................................................
,
... ......... .......ti...
Subdivision i................................................................Lot No. ............ Block No. ............ House No.............
1
Permit No. Date Of Permit A licant ........................................... o
HealthDept. Approval ...Labor Dept. Approval......................................... ................................................
Underwriters Approval ..............................................Planning Board Approval .......................,................ I
Request For Temporary Certificate ........................................ FinaJ Certificate ..........................................
Fee Submitted $ ..5.........00
..................I.......
Construction on above described building an �er S R is�allll aI—s
es a regul tions.
ApplicantB3:... ..... ... .............................
i ip B � MatthAttorney
Sworn to before me this
Y;
,,18th,,,,.day of .....:.....J'ATIQ...d...197 (stamp or seal)' /5E-0 3.. ,
Suffo 00 Z. 957�
Notary Public ....... .............. ... ... o ty, REM>sEM g. esTRdffbER � h
d Notary Public, State•f%5w York
No. 52-2083305 C-,. �, O>,►'Yu�J
Qualified in Suffolk County.
Commission Expires March 86, 19