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HomeMy WebLinkAboutZ-4855FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~t~8~. ..... Date ............. Oc. tol~er..16..., 19.~. THIS CERTIFIES that the building located at . Cam!~. 14 .~meola .Roa¢l ...... Street Map No. ~ .......... Block No.~ ....... Lot No~ .~t.~tnck..~',[, .......... ~,_~qu$~e~en~s ~o~,~ family dwell~g .& hous~g code conforms substantially to me~2~ ~4~~~%~~ ~Co~if~eat~ .of Oee~p~ey B~ her?re.. April.-2~..., 19.~7. pursuant to which ~~k~l~o. dated .......0e.tober...~6..., 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 .. Prints .one..family. dwa).l~g. & Accaasor~ .~ild~g ............. The certificate is issued to . .~a~s. L.,..~ra~ .... ~er ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~re~ax~.sting .................... UNDERWRITERS CERTIFICATE No.. pre,. e~st~ (~ 9~6). &. ~ 59~8~. ~e. 3P .~9~ ttousH NUMBER. ~ ....... Street...Camp .bi~ola. ~d .......................... .................................................. Aecesso?y build~g~Kitehen, broken w~dow glas~ 3~ / / " " Toilet ro~ leaking pl~b~g & ~F~ rotted floor covering, ........ F v ............./ ~eod~ ~o~i~atio~ tO exterio~Building Inspector ~ ~ Lt~g ro~ n~ed~ l~ght at point of ent~ Ma~ Dwell~g~ ~en ch~ey flue th~ble,~2~a, FOItM NO. 6 TOWN OF $OUTHOLD Building Delm~tment 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 triplicate 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 dispcsal (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 land use 3. Copy of certificate of occupancy $1.00 $5.00 Date 10/10/72 New Building .................... Old or Pre-existing Building ...... ~ ................... Vacant Land ............................ Location Of Property Camp Mineola, Mattituck~ New York ............................................................. ............................................. Owner Or Owners Of Property ...J....a~....e..s.....L..:....c.3..r...a..y.. ............ F~.-..Q.C.,C.~.~,.C......~.~........H.g..w..e...1..1. ............................ 5-Peconic Bay W-Howell Est. Subdivision ................................................................ Lot No ............. Block No ............. House No'QMS... Permit No ..................... Date Of Permit .................... Applicant Health Dept. Approval ........ ..~'....~......~ ......... Labor Dept. Approval .......... .~...: .(.~..;: ......................... Underwriters Approval /..9..~.~....~....~......3..o.../.~.)...0....Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ............ ;i ........................... Fee Submitted $ ...5.3..0..0. ......................... Construction on above described building anfJ'lS'~cnit meets all applicable codes and regulations. Sworn to beforemen__this ~""-~ ! .~ r ~ -~ ~.~ .... ....... ...... Notary ~~ ..... County NobOdY; E. GILLIES PUBLIC, Stere oi New York No. 30-1~36250 Qu(zlified in ~sscu Count~ ~erm EXp~es ~zcb 30, 1973 (stamp or seal~'~ ~