HomeMy WebLinkAbout22295-Z (3)FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
~TIFICATE OF OCCUPANCY
No Z-23988 Date OCTOBER 27, 1995
THIS CERTIFIES that the buildin~ M~LTIPLE ~ESIDENCE
Location of Property 1825-B-5 CALERS WAY (P~T. ~D. 91) GREENPORT~N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 40.1 Block I Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 17~ 1994 pursuant to which
Building Permit No. 22295-Z dated SEPTEMBER 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 ~NIT BS-M~LTIPLE RESIDENCE WITH GA~%GE ~FNDERNEATH -
COMPLEX B AS APPLIED FOR.
The certificate is issued to
of the aforesaid building.
(owners)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-95-0011 JAN. 19~ 1995
UNDERWRITERS CERTIFICATE NO. PENDING - OCTOBER 19~ 1998
PLUMBERS CERTIFICATION DATED OCT. 20, 1995-A~'f~UR MALAUSSENA, JR.
/ ~Bu~lding Inspector
Rev. 1/81
BLDG. DE !:T.
A?PLiCATION FOR CERTIFICATE OF OCCUPANCY
A. 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:
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 wn=er 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 instaiia'tions, a certificate-of Code Compliance from arahitect 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 buitdings~,and
"pre-existing" land uses: ~
~. Accurate survey of property showing all property lines, streets, building and
unusuai 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 tim
reasons therefor in writing to the applicant.
C. Fees
l. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling S25.00,
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[ Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
~. Updated Certificate of Occupancy - $50.00
5. Iemporary Certificace of Occupancy - Residential $[5.00., Commerciai $15.00
'ianning Bonrd Aporovni ........................
~equost for: Temporary Certificate ........... Fin;ti Certicace ...........
o ..........
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