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Home My WebLink AboutZ-4663FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...E.~..S..e.a.v. 0.od.' D.r. ......... Street Map No.l~®&¥~.c<[. &.c.rBllock No ........... Lot No..1. .~ ...... .8.0~..t.h~..],.d.. N...Y: ........ Re~irement~ for o~e family dwelliz~ &'kltOU~LTAI code conforms substantially to the.~i~h~r=~'~= ~,~tlSJ~q~lrp~tn~llal~l~l~'a~r~l~'=~"~'=*="za Built Certificate of Oc~p~cy before &pwl~ ...... , l~.%9~ursuant to which M~~ N~b$$3 ... dated ........ g~e .... ~.W .... , 1~.~., 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 .~l~te. ~e. f~ily .~we~g ....................................... The certificate is issued to . Geo,.ge. & Do~o~y. V~eWo~a. (fo~er~ .SEal, a). ~ern (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...P~ .ex~tint ................. UN~Wa[T~S *a~T]~]CAT~ No .... DreTe~in$~n.~ - tIOUSH N UM BH R. ~ ~20 ....... Street .....~.aawoo~ .DTo~ ............................ Building Inspector / S-191088 s/w S-191089 NOTE: · =MONUMENT SUBDIVISION PLAN FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON ,JUNE 26, 1956 AS MAP NO. 2575. SURVEY FOR GEORGE VANDEWOUDE &DOROTHY ~/ANDEWOUDE LOT 16 !'SEAWOOD ACRES, SECTION I" SOUTHOLD TOWN OF SOUTHOLD SUFE CO., N.Y. GUARANTEED TO: DIME SAVINGS BANK OF BROOKLYN SCALE: I% 40' INTER-COUNTY TITLE GUARANTY 8, MORTGAGE CO. FEB. I O, I966 ..o~S~'~[.~E R AND LAND SURVEYOR~ N.Y.~ LIC. NO. 12845 RIVERHEAD. N.Y. FOR~ NO. 6 TOWN OF SOUTHOLD Building Deportment 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 3. Copy of certificate of occupancy $1.00 $5.00 Date .......,].g~ .e.....1. ~....1. ~.7..2. ............. New Building .................... Old or Pre-existing Building ..... .)~...~..~.~..~. ...... Vacant Land ............................ Location Of Property Lu.r...k6e..~'~q3..r,f..,~e.~wno~l,..A~r~s..~e~£ion..D~e...~o~Z:hold ............... Owner Or Owners Of Property .... .Ge.e~.g.e~.~`~.~n.d.e~.u.d~.~J.~a~d~.~..~:~y.~g~adg.Wp~ud.e Subdivision J4a. p..x3;~..~e_aw~3ori.4~T.:e.s...qec, l::.t.dmt Islne...L6 ....Block No ............. House No ............. Permit No..]~gXI, f~ .......... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...E~....~..s.~.~.~.~x...b...u.~..[..d..~..n.~. Fee Submitted $ ..~....~.A.O..O. ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ....... .g...e..o..~ .g;...e.....~..,.....V..a. ~ .d..e.....~...o.?...cl..e....~ .:'..: ...................................... Sworn to before me this ~-.~. ............ day of ..~l'.U..!)..e.....]..~..7..~ .................... Notary Public .................................... County JOSEPH J. SNELLENBURG II Notary Public, State of New York Qualified in Suffolk County No. 52- 9091250 Commission Expires March 30, 1974 (stamp or seal)