HomeMy WebLinkAboutZ-9414FORM NO. S
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . AW4 .... Date .....;aMAarY ..30.......... , 19
THIS CERTIFIES that the building located at ... e' :Ave ........
Map No ............. Block No........... Lot No................................. .
MOR TO
conforms substantially to the
dated .. AVU.. a3......... , 1937. pursuant to whic�i CAA
APO"."Z1044
dated.;$A% ry, ..30.........., 19.. 72 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 ... PJ:iVate .One 1AWay. Dwelling .w/. w .reatai. ppe IV taeut• Amex
The certificate is issued to ...... 4eba.0aston...... .
( owner, 115pF )
of the aforesaid building._ej
Suffolk County Department of Health Approval ........ ft" •A .
UNDERWRITERS CERTIFICATE No . ................
HOUSE NUMBER .............. Street ....... LQ1 "trl n a ............
.......................................... ...e� .... i.............
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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-
tor 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 installa-
tions, 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:
X 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
X 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
Date . � .a� ��..............
New Building .............Old or Pre-existing Building ....?�....... Vacant Land .............
Location of Property .. Equestrian Avenue, .................. Fishers _Island .. , .... .
House No. Street Hamlet
Owner or Owners of Property ...... John Gaston
County Tax Map No. 1000 Section .... .......... Block ............... Lot ................
Subdivision .................................Map No............... Lot No.............. .
Permit No. .......... Date of Permit ..........Applicant .. John.Gaston ....................
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 an er it meets all a plic codes and regulations.
Applicant.. ... ....... ...........................
Rev. 10-10-78 * 533
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111311'7
JOHN GASTON
V 22 74
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