HomeMy WebLinkAbout9215-z ' FORM NO. 4
TOWN OF SOUTHOLD
BUI/~DING DE?ARTMENT
Office of the Building Inspector
Town Hall
Southold, N,Y.
Certificate Ol: Occupancy
No...~1222,4 ........ Date .... JARTftIAR¥. 2,6 ................. 19 8&
THIS CERTIFIES that the buildh~g . .4v.e.1.1.i. .rig..&.. gT.e.e.n..h.o.u.~e. .....................
Location of Property ...3.5.3.9.. ?.02..i~..QK...PO.., ............. .1~. ?.~.~.?.Ug.K. .................
House No. Street Hamlet
County Tax Map Ho. 1000 Section .. ].~.3. ...... Block ...... 3. ........ Lot ....... 3 ........ ::=
Subdivision ............................... FLleA Map Ho ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore Fried in this office dated
· .~[PSil;L. 211 .......... 197.7.. pursuant to wluch Building Permit No. 92.1.4g.-.-.-..92.1.~ ....
dated ... ~,.P.I~ L..2.~t ............... 19.7.7, 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 .........
(owner, lessee or tenant/
of the aforesaid building.
Suffolk County Department of Health Approval ....BI~'.A. ...................................
UNDERWRITERS CERTIFICATE NO ........... .N/.&. ...................................
Btnldmg inspector
Rev.
FORM NO. It
TOWN OF SOUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
In,ructions
This application must be filled in typewriter OR ink, and subn~itted in duplicate to the Building In~.
tar with the following; for ne# buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unu~_
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 .building~ and insta:
tions, a certificate of Code compliance from the Architect or Engineer responsible for the buildi:
5. Submit Planning Board approval of completed site plan requirements where applicable,
B. For existing buildings {prior to April 1957), Nonconforming uses, or buildings and °°pre-existir
land uses:
1. Accurate survey of peoperW showing all property lines, streets, buildings and unusua; natural
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 info~,,
lion required to prepare a certificate. ' /
C. Fees: '
1. Certificate of occupancy $5.00 / * ,.
2. Certificate of occupancy on pre-existing dwelling q~r land use
3. Copy of certificate of occupancy $1.00 [
Date.. January 24, 1984,
New Building . .. X Old isti ildi g(X) 'V~cant L d"
........ ,. or Pre-ex ng Bu n .... an
Location of Property Cox Neck Road, Mattituck, New york 11.95~
House No. Street Ham
Billy p~nt th~ rp
Owner or Owners o~roperty ........ Joe. Car er and Ca eeh V. Ca enter
County Tax ~ap No..1000 Section .... ~. ,~.3, ~ ......Block .... 3. .......... Lot ~.~. ~. ,~..
Permit No. ,9.2.[.~ .... Date of Permit 4. ~/.2.8./.7. .7. ..Applicant ?.i. 1..1~' J.. Carpenter'
Health Dept App oval .~/.~ ' L~ibo Dep~ Approval ~/2% '
Underwriters Approval .... .N./.% ................ Planning Board Approval .N./.A. .............. ,,
Request for Temporary Certificate F~nal Certificate' ~ '
Fee ~ubmitted S 5~.0.Q ........................
Construction on above described buitding an~l~ern~W me~e~s al~'~pl~cable_~pdes and regulation~
~ , / 7 /~ .~ '
,:'~ /,: ,'/ , : /, ,. ~, . .
Apphcant . % .,. ~. .... ./.~.. ~;., ,~;,~., .................. ; .... ...,
~;:~o4o.~a ~11~ ~. Ca~pe~[e:
5. NUE, 'EIVERHEAD, NEW YORK
formerly
now or formerly Car
W. Pausewang
UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEy IS k VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW
COPIES OF THIS SURVEY MAP NOT EEA~IN(~
THL LAND SURVEYoR's INXED SEAL Ok