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Home My WebLink About8881-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....Z.q.4.. ~ .2.q ........ Date .......... .J.u.n.e...~,7 ............... 19 .8.6. THIS CERTIFIES that the building ..... a.q c..e.s.s. 9 .~y' .g ~. 9.p.a.ge...b.u.~.l.d. ±.n.g, ........... Location of Property ...555.0 .............. B..e?&e.n...ay.e., .............. Ra.~..~.i.~.u.c..k .... House No. Street Ham/et County Tax Map No. lO00 Section ..... 1. .l ~ .... Block ........ .7 ......Lot ....... ~ ......... Subdivision ............. }( ................. Filed Map No ..... X....Lot No ...... .X. ...... conforms substantially to the Application for Building Permit heretofore titled in this office dated ·...S.ep.~.e..re.bp.ri...2.4 ..... 197.6. pursuant to which Building Permit No ..... 8..8.8. q.Z. ........... dated ...... .S.c.p..~ 9.m.b.e..~..2./4 ........ t 97. .6., 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 ......... .... ~.c.c.e..s .s.o.rl. kr' .s.b. qp..ag.e..b..u>~.~..rig.. ........................................... The certificate is issued to ................. L..E.O..D.....&..~. I..L.L.:[.qE..~.:r..a.... ~.u.a.s..~.L.L. ....... (owner, ~]~fCyp~ xe~,~J of the aforesaid building. Suffolk County Department of Health Approval ..................... ~./.~. ................. UNDERWRITERS CERTIFICATE NO ............................ .N./.A. .................. Building Inspector Rev. 1/81 FORI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, ~q~. Y. No. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FU~L CO~V~PLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: .......... ~ .e..9...~.:... ~.s...a..e...x.~ .................................. t Bergen Ave Matt~tuek, ~ to ............ .~.~5~...~.?...~s.?.?..~ ~..o..r.z..~..~_o.r~.~....ku.~g Ln. ~ ............. i.., ...................................... 8/8 Bet en Ave · at premises located at ...................... .i~....: .............................................................. ............................................................... ~.a..~.~.~.c~ ............................. .~: ......... :._...,.:.: ........................... : ................................................. . ............. :. ......... :?...;.~ ............. 2.f:..~ ..... ::: ........... '. ....................................... pursuant to appl(cation do~ed ~ / ~ '~ Sept ........................................................ , ...... d roy d by Buikling Ip_spector. ~e ~...LO..'..~ ......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s application must be filled in typewriter OR ink, and submitted t mm,m~m to the Building Inspec- tor w~th 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 disposat--(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 installa- tions, 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. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certihcate of occupancy $5.00 2. Certihcate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~./.~ 5.Updated C.O. $15.00 Date ~l~-- New Building .....~. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . House No. Street Hamlet Owner or Owners of Property . ./'-..¢~....~... ~../~. ?..,/~../.C¢~...~. :....~?. 7%....~?.c, .............. County Tax Map No. 1000 Section .../~..-~ ....... Block ...... ~ ....... Lot ....... S.'~. ...... Subdivision ................................. Fded Map No ........... Lot No .............. Pel it No ~:~'1~-/ ............... 'm ........... Date of Permit . .~./?.¢ ..... Applicant ~/~" ~ Z2, .~.?. ?.-s...~z,_~.c, ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~ .................. Fee Submitted $...~ ................... Construction o.n above described building and permit meets all applicable codes and regulations. -~Q~% ,~E:), 9-ot~-l'~ Applicant...~..~.~.o.....~.;....~F.,F.~..z/:_. .......................... Rev, 10-10-78 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [/] INFLATION/ FRAMING ~ FINAL REMARKS: DATE INSPECTOR