HomeMy WebLinkAboutZ-9569 A FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No. X9569........... Date JAtie. z6r 19 T9
THIS CERTIFIES that the building .
Location of Property ..173~ Park . Ava.. • • • • • • . • • IdattlttatOk ]y~ y
House No. ~ Sweet ~ ~ He'm%} ~
County Tax Map No. 1000 Section 122 ........Block D2 ..........Lot .......433..... .
Subdivision 7~7f70C .....................Filed Map NQ~ 7Q~...Lot No.
.7W000C.... .
R em~lats !or a ivat~ o>I» ! dwell built
conforms psubstantially to th
pl'101"p111.23 ~ , 19 S7. pursuant to w
u'cH01~8 N~o0.0'uP~~YZ~g9 .
dated JWi*. ?.6~ ............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•~
~.'1YIt~f.0Yi4 .ta~tl,ly. dM017.it1g
The certificate is issued to .......1.'~.Qt14~~..T.. ~l .~4~..~"OM4tJ .
(owner, r~
of the aforesaid building.
Suffolk County Department of Health Approval .
UNDERWRITERS CERTIFICATE NO............ 1~~R .
Bu' di Inspector
R.. ans
FORM NO. 6
TOWN OF SOUTHOLD
Building Departmont
Town Clerks Offiee
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
lastroctionc
A. This application must be filled in typewriter OR ink, and submitted in pUPLICATE to the Building
Inspector with the following; for new buildings or new use:
1. Final survey of property with accurote I«ation of all buildings, property lines, streets, and
unusual naturol or topographic features.
2. Final opprovo{ 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 naturol
or topographic features.
2. Sworn sfiatement of owner or previous owner as to use, «cupancy 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 «cupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
June 25, 1979
Dote
New Building Addition Old or Pre-existing Building X......... Vacant Land
L«ation Of Property .11/s...of Park Avenue, Mattituck; New York (cop~r~ioexs~trvey
Michael J. and Gail Freeman
Owner Or Owners Of Property
Subdivision ................................................................Lot No............. BI«k No............. House No.............
Permit No Date Of Permit ....................A licont Richard J. Cron, as attorney
PP
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning Board Approval
Request For Temporary Certificate Finn) Certificate X.......................
Fee Submitted $ ......5.00
Construction on above described building and pe 'f ~ ,ts ' o e ulations.
Applicant ~~'0~
h o , Esq., as attogney for l~ I Iz~~~~
Sworn to before me this ichael J. Freeman and Gail Freeman l
25.th,. day of .........Junet...1979. (stamp or soap 5,~~{
Notary Public Suffolk..;,._.,,,.. County LANE FLATLEY ~ DD/
NOTARY PUBLIC, State of New York
i --/~b~`~~~J No. 52-4665418, Suffolk County ~
\Fl~-.+rG S~ ~ Gwnmisaion Expires March 30, 19.~,
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