HomeMy WebLinkAbout22295-Z (2)FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
~RTIFICATE OF OC~u~ARCY
No Z-23849
Date SEPTEMBER 5, 1995
THIS CERTIFIES that the building MULTIPLE REEID~/~CE
Location of Property 1825-B-8 CALEBS WAY (P~T. RD. %1) OP~K~PORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 40.1 Block 1 Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Per~it heretofore
filed in this office dated AUGUST 17, 1994 pursuant to which
Building Permit No. 22295-Z dated SEPT~R~ 2~ 1994
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 UNIT B8 -MULTIPLE RESIDENCE - OO~PT~ BAS APPLIED FOR
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
R-10-95-0011 JAN. 19, 1995
PENDINO - AUGUST 28, 1995
AUG. 31, 1995-ARTaUKMALAUSSENA~ JR.
Bu~' ld~ng Inspec~r
3 I
Form No. G
TOWN OF SOUTUOLD
BUILDING DEPARTHENT
TOWN HALL
765-!802
APPLICATION FOB CERTIFICATE OF OCCUFANCY
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 Nealth Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
&. 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 simwing 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
1. Certificate of Occupancy - ~ew 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-existin~ Buildine - $I00.00
]. Copy of Certificate of Occupancy - $20.OO
&. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $~5~00., Co~mercia~$15.00
~ouse ~o. Street Hamlet
9nwer or Owners of Property....~..ff-~..~-~.~....
]ounty Tax Map No lO00, Scctio,,...~ ....... BI,ok .... e.~. ....... Lot...~.~.~ .............
~u6d~v~sion., .................................. F~ $~d N~q~ ............ ~o~ ......................
;lealLh Dept. Approval .......................... Underwriters Approvol .........................
'ianning Board Approval ........................
:!equcst for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ .... .~..~. ~ ~.~.&~.......
0 ks' .........
......
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
CERTIFICATION
Building Permit No.
Owner: ~ t59t9/~ ~[~" ,~/~ ~:
Plumber:
~please print)
(please print)
I certify that the solder used in the water supply system
contains less
than 2/10 of
1% lead.
//¢/~umbers Signature )
Sworn to before me this
~%~ day of
Notary Public,
JUDITH A SING
Notary Pubtic, State ol New York
No 01SI5031228
Expires Aug ~ 1996 Suffolk