HomeMy WebLinkAboutZ-9004l~Olt,~ NO. ·
TO~N OF SOUTttOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No...Z900~ .... Date .... May .... 8 ................ , 19..7.8.
THIS CERTIFIES that the building located at . 5.55. billl..Cr, eek. ~.r, ..... Street
Map No ............. Block No ........... Lot No.
.REQU~ FOR ONE FAMTI.Y DWELLING BUILT BEFORE
conforms substantially to the .~,~;t~Keg~~.~,,
CERTIFICATE OF OCCUPANCY
dated . . Ap.l?.~l .....23 ....... , 19.5.7. pursuant to which P~~0g~t No. Z900/4..
dated . .May. ....... .8 ......... , 19.7..8., 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 .... .PR.1%r. ATE ONE FAMILY
The certificate is issued to Fz-emk J, Heery & wf,
(owner,He~e
of the aforesaid building.
Suffolk County Department of Health Approval ........ .Pr.e-..Ex.:I..z.~.t..ng. .............
UNDERWRITERS CERTIFICATE No. Pre-Existing
HOUSE NUMBER ...5~5 ........ Street ....... Mill. Cr. eek. Em., ..................
............................................. Southold,. Nm,. York .............
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
, Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLIGATION FOR CERTIFICATE OF OCGUPANGY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
Inspector with the fallowing; 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 ]957), Non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey.of property showing all property lines, streets, buildings and unusual oaturol
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
,0,, ... ...:... :. .. ..r. 7:/
New Building ................ Additio,~ ............... O!d or Pre-existing B,uilding ..~... V=cant Land ...........
· ocat,on of Property ........
Owner Or Owners Of Property ~'~' ~ ...... f .--...].....-.~.~,~,~ ~_~,~.~.~.:.~.. ,..,~....,.,;;..~,.. ..~.~..~..~...
........... =..,,. .... ......... ...... ..................
Subdivis on ,- . . U ~'
................................................................ Lot r~o ............. Block No ............. House I~1o,~.
Permit No ..................... Date Of Permit .................... Applicant.., ,~,,, ,~,.,,'~.,~... ,~-',~., .~, ,,, .,,O~, ,A.~.,.~/~, ~.L/
Health Dept. Approval ............................................ Labor Dept. Approval ....................................... ~..,,
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ FinaJ Certificate ....~', ........................
Fee Submitted $ ......~...;.. ~ ...............
Construction on above described building and it meets ' ' codes and regulations
Sworn to before me this
................ day of ............................................
Notary Public .................................... County
(stamp or seal) *./ ,'