HomeMy WebLinkAboutZ-10770FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certi[icate Of Occupancy
No...Z..I. 0.7.70 ....
THIS CERTIFIES that the building .................................................
Location of Property ~ ~-/..~...~.'f~.[5...~T.~.b... ~(.~N.I.c;: .... ^t~'. .
h3us~ N'o: ' S'tie3i ......... ) Ham/et
County Tax Map No. 1000 Section .... ~ ~ .... Block ..... ~-, ....... Lot.. 3..O. ...........
Subdivision ...Filed Map No ......... Lot No ...... - ......
...~P. Ku~..~.2 ....... ,1~ pursuant to w~ch~,,;tm-~ P~* ~ .....................
dated .................. ~ q ~ . .t.~ 19 ~ ~, was issued, and conforms to aU of the requ~ements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
~ ON~ Fi~ '''' ' c-'i' DL~E LL ~l r~ 0H ~, J~o-r
~'(~%k Z),~ ~t ~ Ig £ ~t~,
The certificate is issued to ..................... jo'~;n'e;',~ ......................
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ..................................................
/
...... 5..¢. ........
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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.
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
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 occupancv $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ....~.~.~ ,~, ,~, ,/~,~, ............
New Building ............. Old or Pre-existing Building .... (~ ...... Vacant Land .............
· 3 -z LNg.
Location of Property .................. .6:~. ,~,,..
Owner or Owners of Property .... ~ . .o.~. ~ ................................
County Tax Map No. 1~00 Section ....~.~ ........ Block "'L Lot...~..z~. .......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
.%,
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planni/~J'~d Approval ......................
Request for Tempo rary Certificate, ~ ~,,~, ........... :/y/~ertificate~ '~ 'J' .... ~ ..............
Fee Submitted $....~.'.~.-)~,,_ ................
Construction on above described building an~'~~ c~odes~regutations.
Applicant~~~~~~ .......
,.,. , 'hl
-l'~'l'te. N';' S-gABI~B
HENRY E. RAYNOR,$r.,Chairman
FREDERICK E. GORDON
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITC~E LATHAM, Jr.
William F. Mullen, Jr.
Southold, N.Y. 11971
TELEPHONE
765-1938
November 10, 1981
Mr. George Fisher
Sr. Building Inspector
Southold Town Hall
Southold, New York 11971
Dear Mr. Fisher:
At a regular meeting of the Southold Town Planning Board, Monday
November 9, 1981 the following action was taken:
RESOLVED that the subdivision entitled "Rose Dansker", located at
Peconic, be processed as a "set-off" 106-13.
Yours very truly,
HENRY E. RAYNOR. , CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secret~-ry
cc: Board of Appeals
Gary Flanner Olsen, Esq.