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Home My WebLink AboutZ-5175FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. &Z 517.15....... Date ............. 47....31..... , 1973. THIS CERTIFIES that the building located at ..Lake• .Drive .............. Street Map NoReydon. Shor"ock No. .......... Lot No. conforms substantially to the 'i code Built r. tic to 0 Occupancy d ...before .. 4xil. 23, 19ft.. pursuant to which I f . -_o.z .5115. dated ...... May. ....... 1973 . , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pri'ats . One fam4Y. dU►e313.n$....................................... The certificate is issued to .. Hsrry, Ciabriel:P.n Ac. Wife..... Oxners.............. ( owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Pre- eYlating UNDERWRITERS CERTIFICATE No. prom.. existing ................................. HOUSE. NUMBFR..655........ Street .... L4ke. Dr*?p................................. Exception . to. code.s<............................................................... t+ • No shutoff at kitchen range 508b 2. X/ & W/ entry no light switch 529b 3. Cellar- no shutoff at water htr 508b �i ., .� ...�:� ...... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office 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 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: I. 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 // Date........�.....11...l............... New Building .................... Old or Pre-existing Building .....y................... Vacant Land ............................ LocationOf Property......:�!<!.,r4c.....2i.Y................................................................................. Owner Or Owners Of Property Subdivision ....fit,✓.Z�E ........................ / �`J�:�....�?!�.��...1.!�:�.�/�.-:.....Lot No..�........ Block No ............. House No.. bSS. Permit No..... ......... Date Of Permit ............Applicant Health Dept. Approval ......�/. ... ................Labor Dept. Approval ...... ✓.. ...................... Underwriters Approval ........Al .................... Planning Board Approval ... �� ..................... Request For Temp ery Certificate ........................................ Final Certificate /j Fee Submitted $ ..........:................. Construction on above described building and permit meets all ap icgbl�ee codes and regulations. Applicant .. ...... / ......�t .'��'!.. `__________''.r.................................... Sworn to before me this .... .� ... day of ....M-5).. ......q..1.3..... (stamp or seal) C�� ,0�577s Notary Public��t+.. �3.��.?��.r.... County DP 3 7 TERRI LEE ELAK p NOTARY PUBLIC, State of few York No. bz 26iz5 Qualified in u.`, sc County COMMiSSion Expires March 30, 19 ILI . mar +.. J• � .ti . •1. �, Y _ ` c i "� r. • f : >'� " ..� q '. j"•.T' �A I„M ' g:. ,y s �, � z +s . �, s � t; � .� R i+ , T > tr y,. -. ., J%.i � .._ a -� �•.y-.r 3 _ � - y$4 '.3 gyp. ,�• i ','`.� • '� •4 i' y yam. }•. r. � O w Lot ! 2 • __ ti's . Lamed of PiciGk Y'Scu l e : ao'= 1 - MAD or LANA � � rtf�jMlAlrtK4 , SUiZVEYCD FAQ, a • stoles SAT R 1 C to L. Doo LEY AT• v . a _ . t z ^c� - gg��.+«x ` �`�� rr" p•ti 'fir . 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