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Home My WebLink AboutZ-9761FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy ~o. zgT6't THIS CERTIFIES that the building ................................................ 550 8kipl~e~ La. & 890 Oyster Pen~l~ La. 0zq. ent;, I~,Y. Location of Property .......................................................... House No. Street County Tax Map No. 1000 Section 214 .Block 1 .Lot Subdivision .................. . ....... ....._..Filed Map Nil..,,...d~L~l~L~ig. ~L~L~' 'I~l~i~l~ ~0 confo~s substanti~ly to .. ~. ~ .......... 1~. pursuant to w~ch~No ......... ~J ....... dated ....~..O~..e~..~.?~...~.6. ........... 19~.9.., 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 ......... ........ ~..v,. ?...o¢. ?..v...=~...~...~..~.~.~.~. ?./.,~..~.~ .~.. O~: .................. The certificate is issued to Halnl'y ..................... ?o¥.'~;, ;'.~ ~~, ; ...................... of the aforesaid building. Suffolk County Department of Health Approval ....... .N../.~. ............................... UNDERWRITERS CERTIFICATE NO. Building Inspector Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. Location Subdivision Name of Owner(s) ~/~ Occupaucy (typ~e~ / Admitted Key available Map No. Lot(s). (owner-tenant) Accompauiedby: ~. ,Suffolk Co. TaX NO. ; ¥-/ Source of reqUest D%~ELLING; Type of construction ~~~_ ~storieS Foundation ~-7~-~-- ~ellarz~ Crawl space Total rooms, 1st. F1 ~ Bathroom(s) Porch, type Deck, type Breezeway Garage ~/% Type Heat ~ 'Warm Air FirePlace(s~ / No. Exits ~ Domestic hotwater ~4~ Other ~ 2nd. F1 ~ .3rd. F1 Toilet room(s) / Patio, type~--- Utility room ~ Hotwater ~ Airconditioning Type heater ~ . , ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other Storage, type con'st.. Guest, type"const. VIOLATIONS: Housing Code, Chapter 52 . ,Location Description, Art. Sec. , 3 o- Remarks: Time start~//~/ end ~.'~B la~OB~f NO. S TOWN OF SOUTHOLD Building Delmrlment Town Cledc~ Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 installations, 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), No~-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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ...~..o..y.~ .e. ~., ~.,.....].. ~.?.~ ........ New Building .................... Old or Pre-existing Building ........ .Z.. ................. Vacant Land ............................ Location Of Property ..~./..~..~.~..~..~...e..~..~..~...e..e.~ [.~..~..~.~..e..~...s.....~..az~_...e.). , Or~.e.~.~.,....~..t..Y..~ .................. Owner Or Owners Of Property .,~,~'~...C~......~...~.~.,~cj~..~..~...~.,...~..q~..a~.. .......................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ..~.QD,~-.~...~..~/~X..Q.~,f~.~.~. ........................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....Z.. .................................... Fee Submitted $ ...5......0...0. ........................ Constructlon on above ~~,.. described building and l~ermit s I c codes and regulations Applicant ............................. Sworn to before me this /~JJ~na£ct v~ ciee~, Dy RuctoipA ~ Bruer, attorney 9th ,~...f November, 1979 P blic ....... $.~ ~Q,I,~ ............ County ARY OrANA FOSTE~ NOTARY PUBLIC, State of New York No. 52-4655242, Suffolk County ~missio~ ~pJres ~ar~h 3~.