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Home My WebLink About12873-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z 12518 NO ............. ... .. Date June 7 ]9~ THIS CERTIFIES that the building -: .-.n.e.w.. entrance ...... 200 Horton Road Cutchogue Location of Property.................. ......................................... ... · House No, $~r~et Hamlet County Tax Map No. ! 000 Section .... ~ D.4 ..... Block .... Q ~ ......... Lot .... 0..1.2 .......... Subdivision .... N.~.s.a%u., .F.a.r.m..s ............. Filed Map No. 117. 9..Lot No. ~/.o. 12 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated ... .... l~t~ry. .fi . . ,19 .8.4 pursuaut to which Building Permit No. .....................12873 Z dated ........ F el~Y;Ugl:7. ,1, 7 ....... 19 .8.4., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tlfis certificate is issued is ......... a new en%ra, nc,e. to 9.xisting dwelling. The certificateisissuedto LAUREN .K,R. UG (also known as LAUREN .GRANT) (owner, le~e ot~tene~E, of the aforesaid building. Suffolk County Department of Health Approval .... N. [.~. .................................. UNDERWRITERS CERTIFICATE NO ............ .N[.~. .................................. Building Inspector FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)' N? 125~3 Z Permission is hereby granted to: ..Y'-.,~.~.:,...~:..~ ........ ,z./.7~ .,F",-.- at premises located at ...... .,4Z..~,,~... co~,~ ~x M~ No. ~000 S,~o, ....~ ...... ~=k .~X ............. ~o, No...~/~ ........ Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 ,~ o~e APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: I. 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 peoperty showing ail 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property...~...0..~. ............... :~..."~..~,,~.. '.~..~ ..~.& ........ .~-T,~?..~..~ House No. Street Hamlet Owner or Owners of Property .... .~. .~. ', ..... 1~. . . . ~t[~ .... .~ ~ ~. .~ : . C. ~'~' ~. " County Tax Map No. 1000 Section .... [~..~ ...... Block ,...O../ ......... Lot .... 0.\ ~ ..... ............. q ~- . .l.~, .~ .~.. Lot No. (?/0 . [ .~.~.. Subdivision~X[ .~...0,,)¢, .~..(~'. ~[~,~ ./...~.~) .... Map No ............ Permit No. 1 ,~...~. X .~.. Date of Permit '~ .-'.~.l,.'.~,C~ ,Applicant..~. ~.~.~.¢..0..~..~..~.'.~,..~L.~.'~.. '.~-~5.~ · Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .... ~__~,(~ ~...i ~ ~,~i.~,~ Fee Submitted $ .~. ................... ~ ,, ,~ ~ ~ ..... , Y7 Construction on above described buildin~~~~~es and regu~ FIEL~ INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2o ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: