HomeMy WebLinkAboutZ-9732 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No...7_97~? Date .....October. 2.( 1979.
THIS CERTIFIES that thejtyg ......••L•OT•••••••••••••••••••••••••••'•""""
Location of Property ...................Sigabee• Ho~d• • • • • • • • • • • • • • • • • Lavrei• • •~•Y.
House No. rest Ha /Bt
County Tax Map No. 1000 Section ...144 • • • • .Block ...02..........Lot 02r> .
Subdivision MattltuGk• Park• ~?ropertiea•Filed Map No. .gpq....Lot No. 55A• • • • • • .
Certificate of Occupancy
conforms substantially to the Application for filed in this office dated
Certificate of 0 curiaIlcy
..October..?_3• • • • • • • , 197.q .pursuant to which~No. ~g732•
dated ...October .?_6 .............19 7A ,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 .
.......Vacant. Land. for• •use •of• a •Fr•ivate• •One• l±amiiy •Dwelling•
The certificate is issued to Ja~ea• 3. • DuriTtoWner,~~U • • • • ~ • ~ • • ~ • ~ ~ • • ~ • • • •
of the aforesaid building.
Suffolk County Department of Health Approval N/.R .
UNDERWRITERS CERTIFICATE NO N/R • • • • • ~ • • • • • • •
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Building Inspector
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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-
torwith 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 wpply 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, acertificate 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
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.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy onpre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
October 23, 1979
Date
New Building .............Old or Pre-existing Buildingg Vacant Land X....... .
southerly portion Lot 55A on Old Mattituck Park
Location of Property .Properties, Inc., subdivision ,map, , , , . _ ~tQ!//dC~ ~ 1
House No. Street ~/'~..S:~C ~~p ~ ~ ~ amlet 1-~ _
Owner or Owners of Property James J. Dunne r
County Tax Map No. 1000 Section . , 144 , . Block a. Lot ....~~d 2~. .
Amended
Subdivision ..Mattituck, Park. Properties,Filed Map No. ..801. Lot No. ....SSA... , , ,
James J. Dunne
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate R .
Fee Submitted $ 5.00
Construction on above described building and rmit meet II ap I' ble codes and regulations.
Applicant ~ .
J ~ J . buiuie p/
Rev. 10-10-78 /I ~ Z~ 7 ~ /
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