HomeMy WebLinkAbout9229-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date ..... .Ap.r.i. 1...2.7.:..I .9.8.7. ..........
THIS CERTIFIES that the butldmg . .A.d..d .i.t.i.o..n..t.o...g .a.r.d.e..n..s.h.e..d ...................
8245 Oregon Road Cutchogue N.Y.
Location of Property ................................................ ' ...............
House No. Street Hamlet
County Tax Map No. 1000 Section 9 5 .Block I . .Lot 1 1
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
May 5, 1977 9229 g
..................... pursuant to which Building Permit No ......................
dated May 5, 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 .........
ADDITION TO GARDEN SHED
The certfficate ts issued to HENRY DOMALE SKI
..................... f,, alt l f, /X X ....................
of the aforesaid building.
Suffolk County Department of Health Approval ............ N../.A ...........................
UNDERWRITERS CERTIFICATE NO .................... N ./.A ..........................
N/A
PLUMBERS CERTIFICATION DATED:
Rev. 1/81
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 instaha-
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 p~operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
~ ~ 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings.
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. Certificate of occupancy New Dwelling $25.Q0, Accessory ,$ t0.00 Business $50.00
2. Certificate of bccupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00.
o.o. 0.0o
5.Upc~a~cec3 C.C. $ 50.00 Date ..,~. /. .............
NewC~nstruct,±o~ ...... Cid or Pre-exmting Building . ..~?..F. ~... Vacant Land .............
Location of Property .~.~..~/.~. ................... .~. r.d'..~ .~.0...O..m.. ......... o..~..c~. ~_.
House No. Street I~[mlet
Owner or Owners of Property ..... .~..C.. ~ ,~. ~.....--~..~ f'~ .~7....~..~q'fZ,, ........................
County Tax Map No. 1000 Section ... ~.~ ......... Block ...I ............ Lot.../.! ............
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. (~z~.~ 7..~z'. Date of Permit .~J.~. l'~2 .Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $..~., .C.t~. ......................
Construction on above described building and permit meets ~,~pplicable codes and regulations.
Applicant .......................
Rev. le-lo-78