HomeMy WebLinkAboutZ-11629TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, NEW YORK
CERTIFICATE OF OCCUPANCY
Zfl ~ 629 z~/fi $/$5
THIS IS TO CERTIFY that the
/--/ Land
/--/ Building(s)
/-X/ Use(s)
located at z~355 Wurmeweta Road~ Qut¢i%ogue
Street Hamlet
shown on County tax map as District 1000, Section ~ , Block
12
Lot
· does~-_~m~conform to the present Building Zone Code of the
Town of Southold for the following reasons:
A one family dwelling and its accessary building is a use
for a lot in the A zoned district
On the basis of information presented to the Building Inspector's Office·
it has been determined that the above m~aconforming /--/Land /--/Building(s)
/~/Use(s) existed on the effective date the present Building Zone Code of the
Town of Southold, and may be continued pursuant to and subject to the appli-
cable provisions of said Code.
IT IS FURTHER CERTIFIED that, based upon information presented to
the Building Inspector's' Office, the occupancy and use for which this Certifi-
cate is issued is as follows: One family dwelling with an accessary
buildin~
The Certificate is issued to
of the aforesaid building.
Edward N. & Marie Cartnick
(owner, lessee or tenant)
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO. ....
NOTICE IS HEREBY GIVEN that the owner of the above premises HAS
NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec-
tor to determine if the premises comply with all applicable codes and ordin-
ances, other than the Building Zone Code, and therefore, no such inspection
has been conducted. This Certificate, therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions.
_~ P, uilding inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. 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:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Heatth 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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topo§raphic 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 occupancy on pre-existing dwelling o~ land use'¢'l,¢ 5.00
3. Copy of certificate of occupancy $1.00
Date .....
New Building ............. Old or Pre-existing Building(X) .._~_ .... ~/Vacant Land
Location of Property . .~..,~.~--'~ U~o2v/,.~'~o~F,~ ..~.c~.
House No. Street Ham/er
Owner or Owners of Property ......... ~.~...8~...,~..~'~ ./~. ( . . .~..,~..~..I.~.'..~....~..~. ~.~..(,~L~/I/~ ,
County Tax Map No. t000 Section .... ([I ......... Block ... J..~. ........ Lot .... ~ .........
Subdivision.. ~ .~.~....('.~(~. ~.--~...~.. ..... Filed Map No../.~.'~..~ .... Lot No..~..~..'~. .....
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept· Approval ........................ Labor Dept. Approval ...................... ,..
Underwriters Approval ........................ Planning Board Approval ..................
·
Request for Temporary Certificate ..................... Final Certificate ...........
Fee Submitted S .
Construction on above described building and permit'meets all app~cable~codes and regulations. /[ !/~
A~pllcant ..... ? ...............
Rev. 10-10-78
¢
Sworn to before me this
/~/4 day of~ .19~
~Not ary Pub~-f~ "~
TI~