HomeMy WebLinkAboutZ-9970 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold,N.Y.
Certificate Of Occupancy
No....?9970........ Date June. 5 19
THIS CERTIFIES that the building .
4225 Pequash Avenue Cutchogue
Location of Property
House No. Street Hamlet
County Tax Map No. 1000 Section .~37........Block ....?..........Lot .
Subdivision ...............................Filed Map No. ........Lot No. .
re iremenis fQr a one-~amdwellin b~il~ior to
conforms substantially to the-~p~icatron-fo~r-$~riidmg-Pennrt-hzret fiiedZn ce
Certificate of Occupancy #29970
...April..?~........ , 19 .~.7pursuant to which B~t~di~g-Per~rtibPle-~ .
dated !r~1e. 5 19 . 80 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. Dwellin8. ??t:kk .
The certificate is issued to ...~'fr. AII105. Kincaid & V7ife
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ....LT~R .
UNDERWRITERS CERTIFICATE NO............DT/R .
I ~'i ^
Building Inspector
ae~ ane
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-
torwith the following; for new buildings or new use:
1. Final surrey 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, acertificate 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 surrey 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 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 ....~y.29, 1980
New Building .............Old or Pre-existing Building X........ Vacant Land .
Location of Property ...Pequash Avenue Cutchogue
House No. Street Ham/et
W. A. Kincaid
Owner or Owners of Property .
County Tax Map No. 1000 Section ...137......... Block 2 Lot ...17.......... .
Subdivision .................................Filed Map No. ..........Lot No. .
Richard J. Cron, as attorney
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
X
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ 5 , 00, , ,
Construction on above described building and permit b des regulations.
Applicant ~ .
a J r , as attorney
Rev. 10-10.78