HomeMy WebLinkAbout22024-Z (11)FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
u~KTIFICATE OF
No Z-23166 Date AUGUST 15, 1994
THIS CERTIFIES that the building M~LTIPLE ~ESIDENCE ~NIT
Location of Property 655-16D MEADO~ COURT (PRIVATE RD. ~24) SOuT~OLD~N.Y.
House No. Street Hamlet
County Tax Map NO. 1000 Section 87.1 Block I Lot 16
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office datad APRIL 6, 1994 pursuant to which
Building Permit No. 22024-Z dated APRIL 27, 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 D16 M~LTIPLE DW~.ING WITH ATTA~H~u GArAgE
The certificete is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
SUBJECT TO ONE YEAR P~VIEW
Rev. 1/81
COVE TO~NHOUSES AT SOuT~OLD INC.
S-69
P~uING - AUGUST 9, 1994
AUG. 2, 1994--SRM PLUMBING & H~ATING
ng Inspector /
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
~kPPLICATION FOR CERTIFICATE OF OCCUPANCY
mo
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 Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. 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:
i. Accurate survey of property showing 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 - New 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-existinR Buiidin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. %emporary Certificate of Occupancy - Residential $15.O0, Commercial ~15.00
Date .~./~/~ .......
New Construction ........... Old Or Pre-existing Building ................
House No. Street Hamlet
Onwer or Owners of Property .................
County Tax Map No 1000, Section....~2ql ..... Block .... 1 .......... Lot. ,.l& ...........
Subdivision.......... ................. .. ... .... Filed Map ..... ....... Lot.. .................. . .
........ . ........
Permit N .................uate Of Permit ............ Applicant ..............
Health Dept. Approval ..................... . . ... Underwriters Approval ..................... ... .
Planning Board Approval .. .
Request for: Temporary Certificate .... Final Ce~ticate ......
Fee Submitted: $ ........................... -./(....__
· ·
THE HEW yORK 60ARO C~9£RwRn*ERS
WE ARE iN THE PROCES:~ 3F 15 ~t. ING A
:,
1
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
CERTIFICATION
Building Permit NO. 2/~O~q
Owner: fo~' '/-o~ ~%ooSab ~
(please print)
Plumber:
(please print)
I certify that the solder used in the water supply system
contains
less than 2/10 of 1% lead.
( P/~/mberJ Signature ) -
Sworn to before me this
~ day of
Notary Public,
County
GEORGE R LEWIS
pURLiC. State of ..
NOTARY