HomeMy WebLinkAbout12531-Z Unit 4 Apt JFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No-z j.~. ~- 7.2 ........... Date ...... J..a.n.... ~. 7 ................... 198..6.
THIS CERTIFIES that the building . .C. qn..dp. ?.n..~.~. d~.4...~.P.~, t..3..B..~.d.., d.~4. .............
LocatinnofPr~r*~ 2820 Shipyard Lane East Marion
. v yrs..,House No. .................................................... Street ~t~t~ie~
County Tax Map No. 1000 Section ....0.3.8...0..~..Block .... .0.~ ......... Lot 38
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
F e b. 2 4 ,19 8.3. pursuant to which Building Permit No ..... 1.~ 5 3 J ~ ...........
dated ... O~.~y. 3.0 ................. 19 B.~, 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 .........
i~u 1.t. ip J_e..c~ J-.d.~r~c~..T.l~;~.t. d~.4. 3.p.t~,. t~.J.. $~.c.~tcqt~s..~..c.a.P.. gia.P.a.g .e .............
The certificate is issued to .... ~L.E./~¥~..P. 0~[NT. V.I.LL.~. UE .I.N .C.
ow.o; 'd x ...............
of the aforesaid building.
Suffolk County Department of Health Approval ...... .8./. 3. .0/.8.2.....E?. 8..~ ...................
UNDERWRITERS CERTIFICATE NO ..... N 7 '~ '/2 6 2.
LOFT AREA IS NON-HABITABLE
Rev. 1/81
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Depa,tment
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. 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 installa-
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.
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 buildings.
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 $5.00
2. Certificate of occupancy on pre-existing dwelling $ [ 5 o 0 0
3. Copy of certificate of occupancy $1.00 ~
4.Vacant Land C.O. $5.00
j Date... ; ..~, ~... !2.~.'-..~...
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property...~...~..~..~)... ~'Z"~'¥d./~..~../.~. d.~. j...~.. ~..~-..~..~?./.P.~//. ~./.~..'~..':J -
House No. Street . Ham/et
Owner or Owners of Property .....~..~.~.~.~...5'....~.~{.t.~..~..~-.~.~.~..~..~..~'--~
County Tax Map No. 1000 Section 0'~::~ ' 0 Z Block ..... ,~../. ..... Lot. ~.~
Subdivision .,~ .~= ........................... Filed Map N~. .......... Lot No ..............
Permit No..'-'~-~.. ?. ~Date of Permit ~ ......... Applicant . .~.. ,~4~. ~4~. ~z~F ~.
Health Dept. Approval .... ~ ~.~ ...... Labor Dept. Approval ............... , ........
n ~r e ~ ~/~
U de it rs Approval ........................ Planning Board Approval ....... ~..~ ........
Meque~ for Tempora~ Certificate ..................... Final Certificate .... ~.~ .............
Fee Submitted $... ~.~. [ ................. ~ ~
Applicant /~,~ . .~~ ~ ............
,, ', ;:THE,NEW YORK, BOARD OF FIRE
'10~071 i, ~ ~[ :! :~:. ,=;, ; , BUREAU OF ELECTRICITY
U N DERWRITERS
N 717262
a~d fo~d {o b~ ~ compfiance w~th the req~tlrements of lhts Board.
OVENS
SYSTEMS
NO. OF FEET
OTHER
'2 lO~OkV~tt :m~Sl 1-2 Ton A/C Units
~.~ ~ '~r~ter,
I C
OF HI-LEG
NO. OF~EUTRA OF NEUTRAL
2/0
Lic. 578 GENEiAL MAHAGER
Per ............ ~ ..... ir -
This certificate must not be altered in any manner~ return to the office of the Board if incorrect, Inspectors may be identified by their credentials,