HomeMy WebLinkAboutZ-9767 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
29767 November .28 . . . . ...197.9.
No Date
THIS CERTIFIES that the building .
Location of Property ...'13135 Main Road Rt.. 25 , . , , ..Feet .Ma7r~gn,. Z`t.Y,
House No. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Street Hamlet
County Tax Map No. 1000 Section ~'1.1......Block ...05..........Lot Q~.Q .
Subdivision ...............................Filed Map No. ........Lot No. .
requirements for a one Family dwelling built prior to
conforms substantially to the
Certi irate of occupancy Z9"!67
April 23 19 pursuant to whiclt~9C~Fd4t No.
dated November ?_8 19 79 ,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 .
The certificate is issued to ROn83d J. Edeen.
/owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO .N/R .
.~•'r't~r.. ~~ti~....... .
Building Inspector
Rw 4p9
MBY NO, e ~
TOWN OF SOUTMOLD
Building DepaAeMllt
Tows tlcrks Olfke
SoutheW, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCY~ANCY
lustruetioes
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE f0 Ilre BuildNq
Inspector with the following; for new buildings or new ws:
1. Final survey of property with accurate kxation of all buildinplt, prq»Ay Ikns, ssreels„ and
unusual natural or topographic features.
2. Final approval of Health Dept. of water supply oral sewerope dispatol-lS9 iprn ar agigl).
3. Approval of electrical installation from Board of Fire Underwritsnt.
4. Commercial buildings, Industrial buildings, Multiple Residaras and similar end
installations, a certificate of Code compliance from the ArchiMct a 6tpirMtr nwp~lont M far
the building.
5. Submit Planning Board approval of completed site pkm requiremwNs tslrare applioabM.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buiWMgs and "prtMFhIN~"
land uses:
1. Accurate survey • of property showing all property lines, streets, buildings and unusual nalwd
or topogr~hic features.
2. Swam statement of owner or previous owner as to ute, aocupatey and aardNion d bAldMrs.
Date of any housing code or safety inspection of buildings ar pwmisss, a e11N? pssfMwM is
fonnotion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling a land tw >jS.00
3. Copy of certificate of occupancy 51.00
~ November.» 26~.»1979
New Building Addition Old or Pre-ex' i 8ui~dinp Lend,
~~~tk (-tecn
`7YTwc ~?7aP styR.e7,~
Location Of Property ...See attached survey /vr,-a.,:.~rafl»~.gso~f„-»~YOao»D
Owner Or Owners Of Property Ronald.. J Edeen
Subdivision ................................................................Lot No............. Block No:............ Maw Na......»»..
Permit No Dote Of Permit ....................Applieartt .Ronald»J:..»Edeen»..........»..»..«.....
Health 'Dept. Approval ............................................Labor Dept. Appralnol
Underwriters Approval ..............................................Plarming Board Appralal
Request For Temporary Certificate Final Certiiioote .............»X..»......».............
Fee Submitted ~ .......~.+.Q9
Construction on above described building it of ~~pl~s and regulofisM.
Applicant ~
olph H ruer, Attorney for Applicant
Swam to before ms this
,,,,26th doyaf November...,.r,,.1979;. ~arlsoll
Notary Public ..`~S!F~'~::~ County
MARY DIANA FOSTER YY~ ~ " ~/n/~
NOTARY PUBLIC, Stete of New York ~i NL'. ~1-~-
No. 524655242, Suliolk County
Commission EzDlres March 30, la$1