HomeMy WebLinkAboutZ-14799FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING C.O.
Certificate Of Occupancy
THIS CERTIFIES that the building ....O.n.o...f.a.m.i..ly..d.w..e.l.l.i.n.g :. ·
Location of Property .7.~,~. W.I.G. qI.N~..$T.R.E.~? ............ .G.R.E.E.I$?,O.R.T. ..................
House No. Street Ham/er
County Tax Map No. 1000 Section ...Q 4 ~ ...... Block .... Q O $ ........ Lot...0.2.Q ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
..... ~e~qu~re,me~.ts.for~ a p.~.iva_te one-family,,dwelling built prior
conforms suos[annmiy ~o me .,~l~t~t4omt, or-B~l~mg-Perm~-h~etofi~re-~,-irt-thi~-bf--ficcxt~t~d
Certificate if Occupancy ......
tiq. ~_p.r.J~$. 2.3. ...... 19 ~.7. pursuant to which l~ll~'g-l~l'ffil~ No ......................
dated . .~..u~.u.s.~...1.3 ................ 19..8.6, 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 .........
.. 9 .n.e.. f..a.m./.%~..d.w.e. ~..~ ./.n.~ .. ............................................. ::. .......
The certificate is issued to . . .E.~ .T.A.T.E.. 9¥..%~.I.~..c. 9.B.B' ................................
(owner, tR.lt~O~K~lfstO}~
of the aforesaid building.
Suffolk County Department of Health Approval .......... I~./..3. .............................
UNDERWRITERS CERTIFICATE NO .................. ~./..3. .............................
Building Inspector
Rev. 1/81
FORM NO, 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCYL_~rq ~. ~!~.
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 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.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to AISril 1957), Non-conforming uses, or buildings and "preexisting"
land uses:
1. Accurate survey of pa:operty 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
$15.00
Date ~1:. ~/~§ ....
existing Building x Vacant Land
New Building ............. Old or Pre- . ........................
Location of Property ........ 7.[.2 ~.i.c~. in.s .S.~.eet,. G.~...e~o...~c.: .N:?:
House No. Street Ham/et
Estate of Annie Cobb
Owner or Owners of Property ............................................................
County Tax Map No. 1000 Section .... .0.4.8 ........ Block ....0.]- .......... Lot. 9.29 ............
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 $ ,[,5;,0,0
Construction on above described building and p~mit meets all tl~5~licable codes and regulations,
~ _. Apphcan ~.. ...' .
/.
R~. 10-10-76
3oo2
c.c. z,
STATE OF ~ YORK
COUNTY OF SUFFOLK
SAMUEL J. GLICKMAN, being duly sworn, deposes and says:
That he is a practicing attorney with offices at 114
Main Street, Greenport and he knows of his own knowledge that
the pr~mises 712 Wiggins Street, Greenport, New York is over
Sworn to before me this
llth day of August, 1986.
ELF~NOR TERMINI
NOTARY PUBLIC. Stlte of New York
#o. 52-9304670, Qualified in Suffolk Couflty
Co~loloo Expires March 30,