HomeMy WebLinkAbout9132-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22326
Date MAY 17, 1993
THIS CERTIFIES that the building_
Location of Property 410 AIRWAY DRIVE
House No.
County Tax Map No. 1000 Section 123
Subdivision
ADDITION
MATTITUCK, N.Y.
Street Hamlet
Block i Lot 2
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 21, 1977 pursuant to which
Building Permit No. 9132-Z dated MARCH 29, 1977
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 MAIN BUILDING AS APPLIED FOR
The certificate is issued to J. PARKER WICKHAM
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N-467147 - FEBRUARY 11, I980
' ' Buildihg~ In~pec{or '
Rev. 1/81
FO~t NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN C;LERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N? 9132 Z
Permission is hereby granted to:
Ifa );.ti.~uck.. Al~'.ba~e.. ~[~ ..............................
....................... ~t~,.~ueh ...................................
to .....B..u...~ ~.~....~.~...~ f[.~ ~.tlon.. ozs..ex& ~.tlng.. ~U~&ne.~ ~.. ( ~n~,ue.t ~,.~.1. )...Bu.l.~d.~ .......
at premises located at ...~z~...D32.~[.~.e ............................................................................................
..................................................... *~a.t,t $~u~k..... ~, :~., .......................................................................
pursuant to application dated .........................]~.~.....~.~ .............. , 19.~.., and approved by the
Buildin9 inspector.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ....................... ... . . . . .
New Construction ..... ~. .... Old Or Pre-existing Building .................
Location of Pro~ert' ~[~ .~..~., .... /~//j~...~ ~..~..~.~ ~.~J ......
}louse No. Street Hamlet
Onwer or Owners of Property...~..~~...~L~ ........................... ...
County Tax Map No 1000, Section. ~[~Block .... ~ ..... ~]. .....
Subdivision ................................... . Filed Map .......... . . Lot .................... ..
Permit No.~/~.............. ~ .Date Of Permit.~~..Xpplicant.~.~.~.~/~.~
Health Dept. Approval ......................... . Underwriters Approval ....................... ..
Planning Board Approval .............. ........ ..
Request for: Temporary Certificate ........... Final Certicate...~ .....