HomeMy WebLinkAboutZ-6892FOB. M NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y,
Certificnte Of Occupnncy
No..Z~..89~. ..... Date ............... l~bllra~..23, 19..~.6
THIS CERTIFIES that the building located at ..... 1~.8.0rgo~l. ROa5 ...... Street
Map No... ~ ....... Block No...~ ...... Lot No.. '~ .... ~uteho$~a~...N,~ .......
conforms substantially to the ~t~l~l~l~l~[~i~ ~]~~li
certificate o~_ oecup&ney
i~ea~e°d~-.. &pr.. ~3 .......... , 19. ~'. pursuant to which llu, itti,,,];~-,,,~¢t N(116892 ....
dated ........ Febura.~y .... ~3 19.75, 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 .Fa~l. ( s.tor&[~ ). but ld~n[ ...........................................
The certificate is issued to .Alex .&. sh~r~$~ .~uho~k~. t~ .Frank .l~e~ide .........
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .N..,~,. ..............................
UNDERWRITERS CERTIFICATE No. pre-. exls,t~a~ .............................
HOUSE NUMBER .... ~ J.~.~0 ....Street ..... Oregon. Rc~a~l ........................
Building Inspector [
FORM NO. 6
TOWN OF SOUTHOLD
0 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 disposol--(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 appllcoble.
B. For existing buildings (prior to April 1957), Nan-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. Certifioate of occupancy on pre-existing dwelling or land use $.5.00
3. Copy of certifioate of occupancy $].00
New Building ................ Addition ................ Old or Pre-existing Building ...... X. ....... Vacant Land ..............
Location Of Property ....~/..$...D.~F,~GO~...~.Q~Q,...CU.T,~,SQ.GL~.,...~..~.Q~,, ..........................................
Owner Or Owners Of Property ......... ~z~,e~..a~d..~£r.].e.~.....~.u...]3...o..s...~..~. ..................................................
Subdivision ................................................................ tot No ............. Block No ............. House No .............
Permit No ..................... Date Of Permit .................... Applicant .... l~i.c~..E.....La.r~ .........................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary CerHficate ........................................ Fined Certificate ....... X ................................
Fee Submitted $ ...5..:..C)..0. .........................
described building and pJ~ni~eets p I' ib~t,e codes and regulations.
Applicant ......................................................
Richard F. Lark
Sworn to before me this
...... day of ...... (stomp or
Notary Public ........... Su/~fo. lk. ....... County ~R¥ £0u
Fron"
~c~Cide
O.
YOUNG & YOUNG
400 OSTRAND£R AVENUE, RIVERHEAD~ NEW YORK
SURVEY FOR:
ALEX ZUHOSKI 8 SHIRLEY ZUHOSKI
CUTCHOGUE
$OUTHO£D
SUFFOLK CO., N.Y.
/ "= 60 ' FEb'