HomeMy WebLinkAboutZ-11642TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, NEW YORK
CERTIFICATE OF OCCUPANCY
N~A'~C ~N4aO t~4~ I-N~ -I~R E4%4 I-S~S
No. Zl1642 4/28/83
THIS IS TO CERTIFY that the
/--/ Land
/--/ Building(s)
IT_I Use )
425
located at 25
Main Bayview Road
Pine Neck Road
Southold
Street Hamlet
shown on County tax map as District 1000, Section 070 , Block 05
Lot 028 , does(~st-)conform to the present Building Zone Code of the
Town of Southold for the following reasons:
a one-family dwelling and its accessory structure is a permitted
use in this 'A' Zoned District.
On the basis of information presented to the Building Inspector's Office,
it has been determined that the above n~aconforming C/Land /Z/Building(s)
/Z/Use(~) existed on the effective date the present Building Zone Code of the.
Town of Southold, and may be continued pursuant to and subject to the appli-
cable provisions of said Code.
IT IS FURTHER CERTIFIED that, based upon information presented to
the Building Inspector's Office, the occupancy and use for which this Certifi-
cate is issued is as follows: one-family dwelling with an accessory
structure.
The Certificate is issued to the Estate of Rose Mailes
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDEI~WRITERS CERTIFICATE NO'. ..... N / A
NOTICE IS HEREBY GIVEN that the owner of the above premises HAS
NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec-
tor to determine ff the premises comply with all applicable codes and ordin-
ances, other than the Building Zone Code, and therefore, no such inspection
has been conducted. This Certificate, therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions.
~y Building inspector
M-3390
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-
tor witt~ 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.
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 line.s, streets, buildings and unusual natural or
topographic featu res.
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-exis~Ling dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Permit No ........... Date of Permit .Applicant
Health Dep:t. Approval ........................ Labor Dept. Approval ........................
UnderWriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Fin_~l Certificate .......................
Fee Submitted $.
Construction on above, described building and permit meets all applicable codes and regulations.
New Building ............. Old or Pre-existing Building .... X/~r ~.~Vacant Land
Location of Property ...I~./.~./.S..,~ N.E.C.~ ,~.O..J~, AND MAIN ]],~.¥ V~T~/ ROA]).~ SO~O~])
House No. Street Ham/et
Owner or Owners of Property .... ~p.S,~., .~..[..~..S. ~ ..................................
County Tax Map No. 1000 Sectibn .... 7..0...0.0. ..... Block .... .0.~.~ .0.0 ..... Lot .... .0.2.8....0.0.0....
Subdivision ................................. Filed Map No ........... Lot No ..............
M-3390
STATE OF NEW YORK )
)
COUNTY OF SUFFOLK )
SS:
RENSSELAER G. TERRY, JR., being duly sworn, deposes
and says that deponent is the attorney for William Grigonis,
Executor of the Will of Rose Mailes, dec'd., the applicant for a
pre-existing Certificate of Occupancy; that deponent knows of
his own knowledge that the dwelling house on said premises was
constructed and occupied long prior to 1957; and that no changes
have been made subsequent to the enactment of the zoning
ordinance; that attached hereto is a survey of said premises.
(Rensselaer G. Terry~f~.) ~
Sworn to before me
this /~/day of April,
1983.
VNotary Public.
SANDRA g BERRY
~l~llry Public, State of New
No. 4694689
-- QUalified in Suffolk Cou_nty
T~m F.~ires in March 30, 19