HomeMy WebLinkAboutZ-10819FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z30~1.9 .........
Date ....... ~Qcem%a~.J~ ............. 198J.
THIS CERTIFIES that the, building .......................... ......................
Location of Property . .~5.375..C.m,m.ty..go.a.d..40..k .30.25..Y. 9.ur~.g~..Ay.e.,...S. qu..t!~.o.l.d....
House No. Street Hamlet
County Tax Map No. I000 Section . . 05.5 ...... Block ... 13.1 .......... Lot .. 0.1.0.,009 .......
Subdivision ........ X .................... Filed Map No.. X... -..Lot No...X ..........
Requirements for a pre-existing storage warehouse building built
conforms substantially to the
Certificate of Occupancy
Pr. loP..t.o, gp,v..11.2~., 19.57pursuant to which ~ei.ld-i~laerm.i.t-No ........... Z 108.1.9 ....
dated ..... Doc.e. mbep.. 16 .......... 19.8 ~, 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, .stoP. age. ~.av. eho.uae, kuilil,i.ng, on..a.a.o.t, .Off..10.1;..1.0§.-.1.3..tS. Er..a.n.t.e.d...by.
the Planning Board, 12/7/81 with condition*
The ccrti£icate is issued to ....... LO~i.G · IS&AND. ~A~LI~.LOWE~ .ASSD.CIATZQN ..........
(owner, ~-to~ao~)
of the aforesaid building.
Suffolk County Department of Health Approval ........ N/~
UNDERWRITERS CERTIFICATE NO ................ N/.tt. ..............................
*Condition--"that the driveway in
property be used."
the southwesterly corner of the
............
Rev. 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Depai-~,~ent
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-
tor 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 feature~
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, 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 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.
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, 1981
New Building ' Old or Pm-existing Building .... ~ ....... Vacant Land .............
Location of Property . N../S...MJ~.d.d.l.q'..R~a..d..&..W/.S..R.aj .lr..o~..d..Ay.e: .,..S?.u~..o.l.d.:: .N~.w..Y..o.r.k. ....... ; ....
House No. Street Hamlet
Owner or Owners of Property 'LONG IS,..L~.. CAULIFLONER ASSOCIATION
Count/Tax Map No. 1000 Section . .0.5.5. .......... Block ...0.1 ........... Lot..0.1.0...0.0.0. .......
Subdivision ................................. Map No ............... Lot No ...............
Permit No ........... Date of Permit .......... Applicant ' ' ..
Health Dept. Approval ........................ Labor Dept. Approval -
Underwriters Approval ' .Planning Board Approval ....................
Request for Temporary Certificate ..................... Final Certificate X
Fee Submitted $ .5...0p .........................
Construction on above described building and permit meets all applicable codes and regbl:~tions.
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