HomeMy WebLinkAboutZ-11174 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.. Z ~.1.? ?4'......... Date September. 9 19 82
THIS CERTIFIES that the buildings ~ ~ ~ .
Location of Property .41,1?,,,,,,.„.,..,._Sti,llwater,A,venue,,,,,,,,,,Cutchogue
House No. Street Ham%f
County Tax Map No. 1000 Section ~ 37 .......Block ~.1...........Lot Q09.......... .
Subdivision M...S . , I~',and Sec t....1 , , , . , , .Filed Map No. 73.Q ....Lot No. . ~ ? .
Requirements for a private one-family dwelling built ppior to
conforms substantially to the ttpplioatirnrfrn-$rrikiaig-Permih-h~etelofvtefited-in-ttds-officedated
Certificate of Occupancy
..,April 23 ,,,211.1,7.4,,,,,,,,,,,
. 19 5 T. pursuant to which B'aiMing^PeTmlt No.
dated $eAtember 9 , , , . , 19$?. ,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 private one-family dnellinp;,add accessory ono-car r~ara;*_e.
The certificate is issued to Phyllis..L. ,Johnson
(owner, k~eewtenantl
of the aforesaid building.
Suffolk County Department of Health Approval n/r,
UNDERWRITERS CERTIFICATE NO.......... , n/r . . . . . .
~ iii
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Building Inspector
Rev. 7/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Ha0
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-
torwith 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 buiidings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect o~ Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buiidings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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 buiidings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
lion required to prepare a certificate.
C. Fees:
1.
Certificate of occupanc on re-existin dwellin or land use $5.00
opy o cer i icate o occupancy 1.00
Date.x
New Building .............Old orPre-existing Building~X} . __3 (Vacant Land
CC
Location of Property ...v~. {~.~.S..J
House No. p I Street H miei
Owner or Owners of Property ! l ~ l 5 ~J:Q.~ ~ .~,?-.~1 .
County Tax M(
amp No. 1000 Section ! Block Lot ...QUf. .
Subdivision . ! : ................Filed Map No. ..:G ~Q..Lot No.
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval .................Labor Dept. Approval .
Underwriters Approval ~ ................Planning Board Approval ...~,./.........:..r. •
Request for Temporary tCertificate .....................Final Certificate .....Y.:......... -
Fee Submitted S ~J.!
Construction on above described building and perm'r m is all applics~ble~odes and regulations.
Y~r
Applicant . ,7~.~:.,,.. _ - , .'1'`'L':.'"~~--~ . .
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Rev. 10-10-78 pq ^ _ ~ O_ 1 ~1
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