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- TO~~ -?F SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TO~trN HALL
SOUTHOLD, NE~~' YOP.K
CERTIFICt'1TE OF OCCLTYI\NCY
NONCONI'OR1'IING PP.EI\IISI?S
TIIIS IS TO CERTIFY that the
/X/ Land Pre C.O. Z-16]48
/X/ Building(s) Date- September 9, 1987
/ / Use(s)
located at 200 Gin Lane Southold, New York
Street Hamlet
shown on County tax map as District 1000, Section 088 Blocic 03 ,
Lot 6 does~not~conform to the present Euilding Zone Code of the
Town of Southold for the following reasons:
Insufficient total area; rear setback of shed
On the basis of information presented to the Building Inspector's Office,
it has been determined that the above nonconforming /X /Land / X/ Building(s)
/ /Use(s) existed on the effective date the present Building Zone Code of the
Town of Southold, and may be continued pursuant to and subject to the appli-
cable provisions of said Code.
IT IS FURTHER CERTIFIED that, based upon information presented to
the Building Inspector's Office, the occupancy and use for which this Certifi-
cate i3 issued is as follows: Property contains 1 z story, one family, wood framed
dwelling; addition permit 4I13273Z/CO 216080; accessory shed; pond, all situated in
'A' Residential Agricultural zone, with access to Gin Lane.
'i'he Certificate is issued to ROBERT & JEAN ERATH
(owner, 1~~~~~X~~i~€~X
o` the aforesaid building.
Suffolk County Department of I:Iealth approval N/A
L'I~'DI?1Z~'~~R1TEits cr1~,T1F1cn~rE No. Ns27277
NOTICT: IS 1IER,EI3Y GIVEN that the owner of the above premises ILAS
NOT CONSENTED TO 11N INSPECTION of the premises by the Building Inspec-
tor to determine if the premises comply with all applicable codes and ordin-
ances, other than the Buildinn 'Lone Code, and therefore, no such inspection
has been conducted. This Certificate, therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions.
~ •
~,u~~iidi::~ ~nsl~zctor~V-
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
- Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ 6~..ra~ 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 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, 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 pYOperty 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 $25.00 BUSINESS $50.00 ACCESSORY $10.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5 . 0 0 , over 5 years $ 10.0 0
4.Vacant Land C.O. $ 20.00 7 f 2~~~~
S.Uodated C.O. $ 50.00 Date
New Construction , , , , , ,Old or Pre-existing Building Vacant Land
/0(000 n n ~~~-,,~.,~-Q..~..........
Location of Property ~~V . .
. .
House No. Street' • • • Hamlet
Owner or Owners of Property .
County Tax Map No. 1000 Section ....U. Block Lot .
Subdivision .................................Filed Map No. ..........Clot No. .
Permit No. Date of Permit ..........Applicant i~>>/~!~•'`•~........ .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate • . • . • • • • • • • • • • • •
Fee Submitted S . ~ .
Construction on above described building and p rmit meets all applicable codes and regulations.
Applicant . J. . 1?'.. .
Rev. 10-10-78
C~ecr 33) ~ y
~.e eo~IGI~lB
STATE OF NEW YORK:
SS
COUNTY OF SUFFOLK:
Jean W. Erath, being duly sworn, deposes and
says:
THAT she is familiar with the property known as
(No#) Main Bayview Drive, Southold, New York, designated on
the Suffolk County Tax Map as: District 1000, Section
088.00, Block 03.00, Lots 006.000. A copy of a survey of
these premises dated November 24, 1980 prepared by Roderick
VanTuyl, P.C., is attached hereto.
THAT on personal knowledge, information and belief,
your deponent can state that the structures shown on said
survey were built prior to April 23, 1957;
THAT there have been no changes to said structures,
other than normal maintenance, since prior to April 23, 1957
except as set forth in Permit No. 213273 dated
and subsequently covered under Certificate of Occupancy No.
Z
Dated: July o?Y 1987 ~
e n W. Erath
Sworn to before me this
24th day of July, 1987.
i
7 j
Notary ublic
~1
NI~~S~G~IEE
OF~IiE~
COMMISSION EXPIRES AUGUST 31,19p
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