HomeMy WebLinkAboutZ-14450FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No....g.],4 gS.0. ....... Date .... .M.a. ~' . .3 .0. ,. .................... 19.8.6.
THIS CERTIFIES that the building .......... R.E. T&I.L...S?.O.R.E. ........................
Location of Property 12 9 0 0 MAIN ROAD MATTITUCK
h3i s iol ....................... 's't;e3i .......................
County Tax Map No. 1000 Section . .1.1..4 ....... Block ..... .1.1 ........Lot...1..5 ............
Subdivision ............................... Filed Map No ......... Lot No ..............
REQUIREMENTS FOR A PRIVATE ONE-FAMILY DWELLING BUILT PRIOR TO
conforms substantially to the
CERTIFICATE OF OCCUPANCY
...... 37..R.I.5.. 2. .3 ....... 196.7. . pursuant to which I~RIg)[~IX~IIK No ........ # Z 1.4.4 5 0 ......
dated .l~.a.y..3. Q .................... 19 .8.6., 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 .........
Retail store.
The certificate is issued to M. D.L. TRADING
..................... io¥.' ;': dv$1iiffrti ' ir ....................
of the aforesaid building.
Suffolk County Department of Health Approval ....... .N./..A ...............................
UNDERWRITERS CERTIFICATE NO ............... .N./. ~ ...............................
Building Inspector
Rev. 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR C£RTI FICATF OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m ~mmam~ 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 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, 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p:operty 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 $15.0 0
3. Copy of certificate of occupancy $1.00 / ~L / ! .~..//.~..~.
4.Vacant Land C.O. $5.00 .~
5. Updated C.O. $15.00 Date ..............
New Building ............. Old or Pre-existing Building . ~... ........ Vacant Land .............
Location of Property .... l ¢%.~.P.0. ........ '~.~ ..... /.~.~ ........ '....~...i~...l.~'.O..C'..~ .......
House No. Street Ham/et
~un~ O~aOxWr~ers o f p rope rty .... ~..:, .~..: .L. ~ ~/~_~I'~ ...............................
y apNo. lO00Section ,/GOO --,'1.. Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval j~. ~. ~. ,~..--~,~..~.. ..... Planning Board Approval ..... .~.L.~. ..........
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
~ pli,cable codes and regulations.
Construction on above described building meets all/a1
Applicant~,.,~..~L,,~ ....................................... L/t..~
,,.,o.,o.,,