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HomeMy WebLinkAboutZ-9416FORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTME, NT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . 5~ .~).~..C.o..un..t~...R.d.,..2..7 .... ~ Map No ............. Block No ........... Lot No .................................. REQUIREMENTS FOR ONE FAMILY DW~.T.ING BUILT PRIOR TO conforms substantially to the~ CERTIFICATE OF OCCUPANCY dated .April.. 2.2 .......... , 19.57. pursuant to whicBc~T~J~Rla~ No. Z9/+36.. dated .J.?n..u..a~.....5.0. ......... , 19.7..9., 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 ........ .~..~.v.a..~,e..~.e..F, .~..~.Z~, ,~..e.~.Z..~..~ ................................ The certificate is issued to ...G~.°.r.g.e. .D.....W.e.l.d..e.n.-..1~...le..r..&..w..f: ................... of the aforesaid building. Pre-Existing Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No .................. . .P%'.e..-.E~c..i.s..t.i.n.g ............ HOUSE NUMBER. 5~./+0~ ....... Street ......... .C.o..rog..~y..R..o.e.d... #~. 'Greenport, Ne~ York Count7 Tax Number 1000-44-1-11 FORM NO. 6 TOWN OP $OUTHOLD , Building Department Town Clerks Office Southold, iq. 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 dispasal--(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 ote ........ New Building ................ Addition ................ Old or Pre-existing Building .....X. .......... Vacont Lond .............. Location Of Property .....S.?...e.....a:.~...t..a.~.~.?..c]....?..~.~..¥.?..~. ................... ................................................................ Owner Or Owners Of Property ...G..e..~..~..~.e....?.~:....a...n"~..~.~.`~..~.~.~...e.~.~...e.~.u..~..]:.e.`~. .......................................... 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 X Fee Submitted $ ....... .5......0..0. .................... Construction on above described buildi regulations. ........ ~-~u~]olph H. ~ru~er, _~t~o~ en y for Georg'~-D. and Sworn to before me this /' '/ Ella ~eidenmuller ...2..9..~.h...... day of ..~.a..~..~9.?.~..'.....]:.?..7.?.. .......... .. (stamp or seal) , Notary Public ..... .S..u.,~ ~.o...]:.~.. .............. County 'o£ I- 0