HomeMy WebLinkAboutZ-5899 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z 5899...... Date ~ 5th St) . t~'a7 1 ~ , 19.7 )
THIS CERTIFIES that the building located at . Meln . St . ldaw .Suffolk .ASIleet
Map No. xxx Block No... ?~?~....Lot No..?{?~ ..Nevl _Suffo].Ic.. _N.Y•. • • • . .
• ulrem®nt for est cotta •
conforms substantially to the
built before .lpr 23 certificate of oecupanoy
dated . 19 pursuant to which ~idli~Io........ .
dated MaY..... ~ ~ , 19 7~ . , was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy~Or which this certificate is
Accessory guest cottage (former "Fanning :~'srm" boarftiag house)
issued is
Daniel Fogarty Jr & WSPe corners ( 1"armerly Pannin`)
The certificate is issued to .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval pxe- . ®xl~ting . . . . . . . . .
UNDERWRITERS CERTIFICATE No. }:re- existing • • • • • • . • • . • _ , • . , • . • , .
HOUSE NUMBER ..~~5...... Street .Flew Suffolk Ave
X900 New Suffo7.k 3.ane (fifth Std
Building Inspec or
FORM NO. 6
TOWN. OF SOUTHOLD
Building Department
Town Clerks OfFice
Southold, N. Y. 71977
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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 Boo rd 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), Non-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
Dote .....x~~...1974
New Building Addition Old or Pre-existing Building ......?F........ Vacant Land
Location Of Property ......N/S of New Suffolk Avenue & 5th 3treett...New. Suffolk,. N.Y.
Daniel A Fogarty/8n8 Lew Ann Fogarty,
Owr~T~Or Owners Of Property
Sub~i4ision ................................................................Lot No............. Block No............. House No.............
Previous O~~Br:
Permit No Date Of Permit .................,1C74ai[t ....iCG.7~Lt.Y2...~~!ffl~kl~iL~....k
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning Board Approval
Request For Temporary Certificate Final Certificate X
Fee Submitted 5.00
Construction on above described building and permit meets all applicable codes and regulations.
Previous Owner ,
Sworn to efore me is A,~ l~~g
day pf . ; ;?1974 (stamp or seal) / ~J /
No ub ' . ~ Co F S
ff
1k CO
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