HomeMy WebLinkAbout7969-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date June 9, 1988
THIS CERTIFIES that the building .... a.d. dj.t.i.o.n. ...................................
Location of Property 2575 Pvt. Rd. # 7, Diedrick's Road Orient
House No Street Hamlet
18 3 1
County Tax Map No. 1000 Section ............ Block .............. Lot .................
Subd~wsion .......... .X. ................... Filed Map No. X .Lot No. X
conforms substantmlly to the Application for Building Permit heretofore filed in this office dated
May 27, 1975 pursuant to which Budding Permit No. 7969Z
was issued, and conforms to all of the requirements
of the apphcable provimons of the law. Tile occupancy for wtuch this certificate Is msued is .........
....&a.d.t.~.t.o?..0?7.o..a?..~.~i~..t.t.n~ .o~. ?7.f.~.m.t.Z.y' .d¥?.Z.~.t.~.g: ...............................
The cemficate is issued to ~v,~¥ ~l. ~-AP, SS
.................... bZ,,,'oi,,~~ ......................
of the aforesaid building.
Suffolk County Department of Health ApprovaI ............. .'q./.A ..........................
N733677
UNDERWRITERS CERTIFICATE NO .................................................
PLUMBERS CERTIFICATION DATED:
N/A
Roy. 1/81
TO~Ybl OF SOUTHOLD
BUILDING DEPARTkAENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N9 7969 Z
Permission is hereby granted to:
....... ............ ..............
to .... ~./.~.~ ........ .~/.: ........ ~ ...... ~,.,f/..~ ....... ,.f,.~..'~./.,.%i;. ........... .~.!.~..L~L~.!:.~.~.L~z ...............
Ot premises IOCOteO O~* ........................... ~. .......... ~. ...............................;...~,~. ........................................
approved by the
pursuant to application dated /(~ )~ ~'~/ , ~'~- '
........................................................ 19 ........ , aha
Building Inspector.
Fee $.../...~..; ~i .......
Building Inspector
f /
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N,Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec-
tor 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 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.
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 informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ..... .~..U.~.~...~,..I.~.~.~..~...
NewCons truc tion.. ~.. Old or Pre-existing Building ............ Vacant Land .............
Owner or Owners of Property ...~ .1~.~.¢,.'~..!~..1.V.[~.~.~..~..~ ............. ' ..................
County Tax Map No. 1000 Section ..... L f ....... Block ..... .~. ........ Lot ...... / .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ?. ~ .~. t .... Date of Permit .~/~./. 7.~..Applicant .~.~..¢-.~. ~...~'1..~.~..1~.6. f.,:.~..~. ..........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate P/
.....
Construction on above described building and permit ,meets all apphcable codes and regulations.
c,0,® ~l~ ~o ~L~._..~....~.../....,~. ?~..~.. ~. ~.. ~ .~..~ ...........
,~, Ct~, 3qlqq Applicant ....... ,
Re~. 10-10-78 ~