HomeMy WebLinkAboutZ-4672FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
Exceptions to housing codes
1, no heat - summer occupancy only
2, Bathroom- no tub or shower
.Bo light switch at point of entry 529b .
. Partial enclosure under house 302a & 60~b
No. Z..h:.972 ..... Date ............. ,]'a~uary...12.., 19.73.
THIS CERTIFIES that the building located at .N/~ .Scnxnd-V~ew .Ave ..... Street
Map No...xX ........ Block No.. x~ ...... Lot No... x~ ... Southold ... N..¥, .......
conforms substantially to the/~~~e~li~t~ll~n thi~ n*ie~
~a~t. .bOf0~O. Apt. il. 23.., 19..5~ pursuant to which ~~i~To.°eZ~t~C~'
dated ........ January .... ~ 2., 19 F.3., 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 . .pri.~ate. one. faily, dullin[ ......................................
The certificate is issued to . gsta~;e .of. l~arga~.et. LovJ.oy ....... 0~aer ............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Pr.e-.ex:tstLug .....................
UNDERWRITERS CERTIFICATE No ..... I~2~. .... k~lg. 23...~ 9~. .................
ttOUSE NUMBER... 19-99~ .... Street .... SottltC; .View .Ave .............................
....
Building Inspector /
L 1-5M-~o-7o
LETTERS TESTAMENTARY
Thc People of thc State of New York
File No.
703o-71
COBTLANDT POEY
WHEREAS, the last Will and Testament of
~AR,~R~T H. LOVE JOY
SEND GREETING:
deceased, was duly adnl~tted to l~obatc by a D(x'rtq' ~,f O~, Sbrrogat*.'~ (,tort -f Qut~enq County on
U~ i ~ !971 , ~hicb tflrectcd the ,~suance to you of Letters T,.stamentary upon your
qualifying according to I.aw,
NOW THEREFORL'. KNOW YE, that you are hereby authorized to administer the estate of the
said deceased subject to the jurisdiction and supervision of this Court.
WITNESS, ttON.
Surrogate vf ~,~ County of
... C~k of~ Su~6~ Com.
FORM NO. 6
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
SouthoJd, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in ~ to the Building
Inspector with the following; for new buildings or new use:
]. 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 disposol--(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 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
]. Accurate survey of property 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 in-
formation 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 ...;7.3~..~../Z ¢. ~'..~. · ·/r .../~..Z..~... ........
Owner Or Owners Of Property --' ..... ~ ~ · ~ ~ '
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No ..................... Date Of Permit .................... Applicant ..................................................................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approvol .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .......... .~.. .............................
Fee Submitted $ 5,DO ...........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant .B3, ¢' .............. ~or ~z~~~cu Ear .~"~' ' ' ...................................... ^
Sworn to before me this / ~/~ I\
9th. day of ~a~nu.a.r~, .l.R,72~ (stamp or seal) C/., ~
...........................
Not?rY Public ............. ,/~,~/5-~,~'..~. ..... County y~
- ~OO,O
/., ;,,,1 END E D