HomeMy WebLinkAbout9253-zI~ORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No..Z891.6 .... Date ...~.al~ry. 25 ........... , 19..7.8.
THIS CERTIFIES that the building located at 225~..G.~a~l .Avo ........... Street
Map No ............ Block No .......... Lot No .................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .. Y~ay .... 16 . , 19.77. pursuant to which B-ilding Permit No..9~3.~.
dated May ~ 8 ....... , 197F.., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. PRIV/LTE. SW~ING. POOL .~q~[TH. FENCE ............................
The certificate is issued to ...... Ali. an .Dtckerson .............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .. ~./.R. .......................
UNDERWRITERS CERTIFICATE No....N36.].~?!.3 ....... .0.c.t..o.b.e.r...27.t. ? .~7.7. .......
HOUSE NUMBER ...22~5 .... Street ....Gral~ .AYe. ...........................
.......................................... ~t.t. lt~cg~ .l~e× .x. or~. ...............
Building Inspector
MUST BE ~EPT ON THE P~ISES UNTIL FULL
~E THE WORK AUTHORIZED)
~ $OUTHOLD, N. Y.
?
~ I~ILOING P£RMIT
Date . /~¢J~ ' /~ ]92.z
I~ORM NO. ~
TOWN OF $OUTHOI. D
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPMGATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled ,n typewriter OR ink, and submitted in triplicate to the Building
Inspector w~th the follow,ng; 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 fram Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple I~esidences 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 proper~ 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. Dote 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
3. Copy of certdicate of occupancy $1.00
$5.00
New Building ...,~. .............. Old or Pre-e.xisting Building .......... ~ ...... , .......... ~acan? Lc{nd ............................
Owner Or Owners Of Property .................... .~..~t4~k...~:.,....~.'.~...~.i.'~.~.'.~..~..%. ...............................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Perm,t No..~....~..~.~?'. .......Date Of. , I ¢-~Ptermit "'~/'l"~'("t"~":~"'Applicant, ....... ~'~'['~'~'~"1 ..................................
Health ~p,. Approval .......... .~.1.~ ......... .' ............. Labor ~pt. Approval ......... ~.~,~.~Z ..........................
Underwriters AppravoI ~ ~h~ ~'t~-- Plonning D~rd ~pravol ~.J ~
Request For Tempora~ Ce~ificate ........................................ Final Certificate .... .~ ................................
Fee Submitted $ .... ~. ............................
Construction on above described building and per~i~,~eets all applicable c~es and r~ulati~s.
................ .................................
Sworn to before me this
................ day of ............................................
Notary Pubfic .................................... County
(stamp or seql)
ROY H. REEVE AGENCY, INC.
Main Road
MATTITUCK, L I , NEW YORK 11952