HomeMy WebLinkAboutZ-10065 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No....Z10DC5....... Date ........August. '7 ]9 .8D
THIS CERTIFTESthatthebuilding g
Location of Property 3.3L15 .Oregon .Road Mattituek,. N.Y.... .
House No. Street Hamlet
County Tax Map No. 1000 Section .....QA.....Block 3...........Lot . . p,£ .1.2... .
Minor Ruah M. Forquer, Jr.
Subdivision E1.izabeth •E.. Farquer.....6died Map No. a~$ ..Lot No. 2 .
requirements for a one family dwelling built prior to
conforms substantially o the
Certiif c t. .of OcC ancy
....Aprj.7..23........ , 19,57 Pursuant to w~ti~ al~p~. , ...2100£x5 .
dated ....August .7 1980- ,was issued, and conforms to all of the requirements
of the applicable provisions of the law. Tl~e occupancy for which this certificate is issued is .
Private One Family Dwelling with Barn and two (2)
accessory buildings
Minor subdivision No. 1g9 was approved by the Planning Board
July 28, 1980
Pre-existing Certificate of Occupancy dated November 9, 19']7,
issued to Robert and Jean Lenzer, No. 27997
The certificate is issued to ........Rush M. , . JT... slid .Elizabeth. F:...FOI'Auer....... .
(owner, /R1f~C~
of fhe aforesaid building.
Suffolk County Department of Health Approval N/A....................... .
UNDER\VRI"fERS CERTIFICATE NO 1`VA....................... .
Building Inspector
R>~ aria
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 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 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 on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
August 5, 1980
Date
New Building .............Old or Pre-existing Building X....... Vacant Land .
3305 Cregon Road Mattituck
Location of Property .
House No. Street Hamlet
Owner or Owners of Property , , , .Rush M. Forquer, Jr: and Elizabeth F. Forquer
County Tax Map No. 1000 Section Block Lot .
Subdivision .................................Filed Map No. ..........Lot No. .
Richard J. Cron, as attorney
Permit No. Date of Permit ..........Applicant .
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 p it is I ap 'cable o Ad,regulations.
Applicant
R' d on, as attorney
Rev. 70-10-78
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