HomeMy WebLinkAboutZ-11412FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.1.1.4. !.2 .......... Date .... .J.a.n.u..a?.y..5. .................. 19.8.3.
THIS CERTIFIES that the building s....(.2. } .........................................
Location of Property 2005 Pine Neck Road Southold
hi, d,s'o ~io: ................ 's'&;i ..... Ham/et
County Tax Map No. 1000 Section ...Q?.0 ...... Block ...0.5, .......... Lot .... 0.~.5 ..........
Subdivision X
............................... Filed Map No. X .Lot No. X
Requirements for a private one-family dwelling built prior to
conforms substantially to the ,~Pp4ieatio~-fof-'B'uildi~g~-Permit-trer~ofm-e- fit-ext-in-this-crffice, d~
Certificate of Occupancy
. . .Ap.~.~..1..2.3. ......... , 19 .5.7. pursuant to which Rtrflrli-ng-Pel-rrrit- No. Z11412
dated . . . .J.a.n.u..a?y..5. .............. 19 .8.3. , 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 .........
a p. rivate one-family dwelling with one accessory building.
The certificate is issued to JOSEPH B. GUNNISON
..................... ('o~,~'n'e;, 'J'c~'~'~t 't~t~'rl't'J" ................ . .....
of the aforesaid building.
Suffolk County Department of Health Approval n / a
UNDERWRITERS CERTIFICATE NO ...... n / a
· .. ... ':' ::'.-.frY's' ..-"? - ' ?t'.~.xz-.L'~ ...........
Building Inspector
Rev. 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11,371
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tot with the following; for new buildings or new use:
1. Final sur,/ey of property with accurate location of all buildings, property lines, streets, and unusual
natur31 or tooogreohi~ fe3tures.
2. FinataoprovalofHeaith De~t of water supply and sewerage disoosal_(S.'9 form or equal).
3. Appro,,~ai of electrical instaliation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa-
tions, a cert:ficate of Code compliance from the Architect or Engineer responsible~for the buiiding,
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to ,~pril 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all prooerty lines, streets, buildings and L~nusual natural or
topograph ic 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 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 .. November 24, 1982
New Building ............. Cid or Pre-existing Suilding(X) XX -
,~ ~0 ~ ....... = /Vacant Land
Location of Property Pine Neck Road
....................... · Southold
Hou.~ No. - ' ................... ; ....... '. ~ '. · ........
Street Ham/et
Owner or Owners of Property Joseph B. G%uanison
County Tax Map No. 1000 Section 70
................ Block 5 4~
Permit No.. Date of°~ ~-
.......... ~ ,~=.., .Jos~h .B~..Gqz~.s. on' ·
Hca Jib Dept. Approval ' .Labor Dept. Approval ...................... ,..
Under%,zriters Approval ........................ Planning Board Approval .
Request for Temporary Certificate ..................... Final Certificate' .....
Fee Submitted S..5 :.0.0. ................. .
Construct,on on aoove d~cr,bed. Uu,lo,ng a~ee~a,~ca.~.~nd regu latJons.
n,,.~o.~o.78 ~1~, /---[--~- .... ., :, .-.