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HomeMy WebLinkAbout9242-zFOF, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z895R .... Date.. l~rch.. Z0 ............ , 19.7.8. THIS CERTIFIES that the building located at .~.1/45. ~.li~aht. s. [axle ..... Street Map No.. 6065 .... Block No ........ Lot No ...... /, ....................... conforms substantially to the Application for Building Permit heretofore fried in this office dated , I~aY. 12 , 19..77 pursuant to which Building Permit No...9~ dated ~y ~2 .......... , 19 ~., was issued, ~d co~orms to ~ of ~e req~ ments of the applicable provisions of the law. The occupancy for which ~is certificate ~ issued is . .. ~ .ACC~$0~Y .BU~ ..................................... The certificate ~ issu~ to ...Pa~ .& ~g~e~ ~2~ ....................... (o~er,~ of the aforesaid building. S~olk Cowry Dep~tment of Health Approval .. N/~ ..................... UNDERWRITERS CERTIFICATE No ................. N/R ........................ HOUSE NUMBER . .2q~ . .. Street . .. ~~s. L~e ...................... ......................................... Matt~ck,..New..York .............. .. .... B~ld~g Inspector FORH NO. 2 TOWN OF SOUTS0£~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI-HI'S PERMIT MUST BE KEPT ON THI~ PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) ]'OltM NO. 6 TOWN OF 5OUTHOLD ~ Building DeportmeBt Town Clerks OHice Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ln~tructlons A. This application must be filled in typewriter OR ink, and submitted in OUPLICATE to the Building Inspector with the following; for new buildings or new use: vl. 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 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 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ote ..... .......... New Building .......k ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................-. .............. ..L:../. .......................................... .~..~.{..T'....~...C...~..., .......... .. ...... Owner Or Owner~ Of Property ....... ..~-~..../~....Q..~..~.~...--~..~.~...r~).....~..~.~.~.~.~..~.~.~...~.~.-~.. ...... ~.~....'J~...~....H. .......................... Subdivision ~.~.~..L.~!:.]~'~..~.~..~.?.~..~..~../~...~.~....~.~.~.~:~.~..~..~L~t No .... ...L~. .... Block No ............. House No..L/.~.'.~.~ Permit No..~.o~LtL o').,~. Date Of Permit ..-,...:/,.~..2.Z?Applicant J~l~ ~a/~ ~T- /qr. H~TC_~ Health Dept. Approval ............................................ Labor Dept. Approval ---- - Underwriters Approval ........................ :: .................... Planning Board Approval ......... -~ .............................. Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .......... [.../...~ ~,~ .......... .~..1;..; ......... ~ ......................... Sworn to before me this ................ day of ............................................ (stamp or seol) Notary Public .................................... County .X '0 %oP 1~=25 00' L=3$ 27 7HE LOCI~TlO;~' OF Xr,"Er~$ ~KD CESS?OO.T.~ SHOWH HEREIN ARE FROM £1ELD OI~$EBVATION.~ AHDIOR FF;O.t.l DATA OBTAIA'ED £1~01',I OTHEI:$ NO TE: n-- MONU4f£NT ..CUB DIVISION MAPFIL ED IN TH 0~' ThE C£ El?I( OF SUFFO£ K CO UN T Y ON FED 1~ 1974 ,~S FILENO 6065 REVISIONS YOUHG & YOUNG 400 OSTRANDER AVENUE, RIVERHEADj/ ALDEN W. YOUNG SURVEY FOR: P~UL A H~TCH LOT ~0. 4, "ELIJ~H~ L~NE EST~TE~ AT M/~ T TI TUCt( ~ OUTHOI D SUFFOLK CO./N.Y. SCALE: /,,__ ~0' GUARANTEED TO: HOME TITLED/WSION OF CH/CA GO TITLE INSUI?ANCE CO If?IVEY?HEAD SA~NGS BATIK