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FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
Certificate Of Occupancy
No. . . 14414. . . . . . . . Date . . . .—May-1.9. . . . . . . . . . . 19(36
THIS CERTIFIES that the building . . two-family dwelling. . . .. , . , .
Location of Property ,71 1. Linnet ,�t . Greenport
FOouse No. . ., . . Street. . . . . . . . . . . . . . . . . . . . . . . . . . . . .Hamlf
County Tax Map No. 1000 Section . . .4§. . . . .Block . . . . . . . 3. . . . . . .Lot . . 1 . . . . . . . "
I '
Subdivision Greenport Driving .Park , ,Filed Map No. . 369. , .Lot No. . . . 26&28. . . .
conforms substantially to the Application for Building Permit heretofore filed in this office dated
•May _16. . . . . . . . . . . . . 19 85.pursuant to which Building Permit No. , , , 13 9.9 0 Z. . . . ... . . . .
dated . . , . , , June 3 , . . . . . . . 19 85, 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 . . . .. . . . .
. . . Two-familX. dwelling, by
#3303
ZBA. . , . . . _ . . , . . . , .. . .
The certificate is issued to . . . . . . . 1!RANK, A: FIELD REALTY, INC .
. . . . . .
of the aforesaid building.
Suffolk County Department of Health Approval . . . . . .. . . .8 58. . . .. ,
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . .N
I +
.. . . . . . . . . .BuildingInspector
Rev.1/81 m
4
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FORM NO.6
TOWN OF SOUTHOLD
Building Department
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® 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.
S.Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
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*occupancV on pre-existing dwelling $15.00
3.Copy of certificate of occupancy $1.00
4.vacant Land C.O. $5.00
Date . . . . . . . . . . . . ..
New Building . . .I,( . . . . . . . Old or Pre-existing Building . . . . . . . . . . . . Vacant Land . . . . . . . .. . .. .
Location of Property (.� ?�U ¢. . . . . .. 3 20 W h/.. . S/ . . .. . . . . � ��® -7 . . . . .
House;V0.;
o. Street
. Axl k. . L L(� -1 -y ' t pj C_
Ham/et
Owner or Owners of Property .. !, .. . . • • , , (
. . . . . . . .
County Tax Map No. 1000 Section . . . . . T.. . , , • . Block . . . . �. . . . . . Lot. f�,�20, ,
o�
Subdivision . a!ZG� . J�.�.J.�O. . . . . . . . . . . .Filed Map No.PR .G'lodgkot No. . . . . . . . . . . . . .
Permit No. Date of Permit 01� Applicant . )!k F7y.�Apc,
Health Dept.Approval . . . .. . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . .. .
Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . .. . _ . . . .
Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . t%.
�/* 1.
Fee Submitted $. . . :�.r. . . . . . . . . . . . . .
Construction on above described building and ermit meets II ap lic ble codes and regulations. J
Applicant
Rev.10.10.78
-]
RF_AK FLEVATIOkl,
I%
AP,~ZC;';'ZD AS NOTED
NOTIF~ BUILDING DEPARTMENT AT
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1, FOUNr~ATION _ TWO REQUIRED
FOR POURED ~ONCRETE
2. ROUGH - FRAMING & PLLJMBIN~
3. INSULATION
4. FINAL - C(qNSTDUC, TiDN MU~i~
BE C'~^4pl r-TE FOR C O
ALL CONSTRUCT!ON SHA~_L M~E1TM
OODES. NOT RESPONSIBLE FOI~
DI~IGN OR CONSTRUCTION ERRORS~
OF OCCUP/&NC¥
pLUMBER cERTIFICATION
ON LEAD coNTENT BEFORE
C, EI~TIFICATE OF OccUPANCY
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED ~/10 of 1% LF. AD.
I[c copper tubing is u~ed
for water distributing
system; piping shall be
of types K or L only
FRC~T ELEVA.TON
LEFT- 51O:F EL[VATIOIq
5
5;cT!0~ C
J
FLOOR
N~t NOLLV~ NnOJ
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Ntl, ,a NOLLX/dNFIOJ
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