HomeMy WebLinkAboutZ-9602 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.....Z96D2 • Date ........July..2l+ 19 .'7.9
THIS CERTIFIES that the building .
Location of Property 5 Beachwood .&oad ..................GyltChoQ{~s
House o. Street Hamlet
County Tax Map No. 1000 Section ~6......Block ...Q4..........Lot ...Q26.......... .
Subdivision T.~
..................Filed Map No. . X7C ....Lot No. XX .
conforms substantially- foQthe
OF OCCUPANCY
. ,April , 23.... , 19 5.7, pursuant to whic No. ...........29602... .
dated ....................July..2419'79. ,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 .
~x'~.vats .one..Yaa?~.7.X. dWe7.litxg .
The certificate is issued to ..........A11C.e .I~. F.QBCat,4 .
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval . N/R .
UNDERWRITERS CERTIFICATE NO........N/R .
Building Inspector
Rsv 4/79
_ _ ~ .~.w
lOHM NO. 6
TOWN OF SOIITHOLD
building DopoRmont
Town Ckela Offko
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Inakruckions
A. This application must be filled in typewriter OR ink, and submitted in DUPL{CATE 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 Board 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 load use $5.00
3. Copy of certificate of occupancy $1.00 ^ ~
Date ~".1~~~
New Building Addition Old or Pre-existing Building Vacant Lond
Location Of Property ....3.~.~......~ 7e ~(.M~-6F.y.... .Yf!\ ..!!~'4~/..\~,.n
Owner Or Owners Of Property ........~1~.:~.i~..L.Y.I.r..........:Jfrl~.\.~
Subdivision ................................................................lot No............. Block No............. House No.............
Permit No Dote Of Permit ....................Applicant
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning Board Approval
Request For Temporartiticate Fin I Certificate
J
Fee Submitted $
Construction on above described building .and per i t licobl and regulations. I
Applicant ....15~
Sw~oryn~to before this
day of ~ (stamp or seal ~66
Notary Public aunty a`"tA ~ ttrtl Q~ .Qf