HomeMy WebLinkAboutZ-7839FORK NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 278.39 7 � ..... Date ...............Aui;.... 71...., 19..77
THIS CERTIFIES that the building located at / a,�n. o .d............ Street
Map No. XX ......... Block No.... XX .... Lot No.. X ... ?�Iatt.i tw
r qu cements fo bunees buildin
conforms substantially to the (bowling Alleys)
Mated .be.fore..Apr. 23....., 19, 57. pursuant to which Wj=mac. t0` occupancy
° Z7839 . .
dated ......... AVg...7.1.. , 1977 ., 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 . b tsM.e s s0kl} U41zig .. (J)-0WUng. A7.1eY.s.) .............................
The certificate is issued to Xat.tituck .Bow.ling..I,anes.Inc ....... Q=er..........
of the aforesaid building. ( owner, lessee or tenant)
Suffolk County Department of Health Approval ...................
UNDERWRITERS CERTIFICATE No. pre-e<xist1ng ..............................
HOUSE NUMBER ..... 9.900.... Street ....Main Jioad .......Mattituck .........
.NOTE:. This. cattif.i.cate..does. .not. cover• addition. under..00nstructzon. now*
. .. .........
Building Inspe or
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
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
Inspector 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
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:
1. 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.
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 ,August 9, 1977
...............
New Building ................ Addition Old or Pre-existing Building Vacant Land
Location Of Property .S/,.S MainRoads Mattituck, New York (#9900 Main Road)
...................................................................................
Owner Or Owners Of Property Mattituck Bowling.. panes Inc:
....................................................
Subdivision................................................................ock No .
Lot No ............. BI ............ House No.............
Permit No ..................... Date Of Permit Applicant
...........................................................................
Health Dept. Approval ............................................Labor
Dept. Approval ................................................
Underwriters Approval .Planning Board Approval
Request For Temporary Certificate ........................................ Final Certificate...
Fee Submitted $ S.-.00 ...........................
Construction on above described building and Permit ,meet; allpplie'able des and regulations.
Applicant ... ... C',
12acha'rd"*',...i5:fXvr ikVE.or'riey..ior... 0-. .e ...................
Sworn to before me this �' /�lj/77
.....9th .. day of .....august,
(stamp or seoq�a��� 26 Zi
Notary Public .......... Suff.o...lk..........County G` `�" f 33 (2 —
....
MARY LOU DORMKI
(C L J�%,' NOTARY PUBLIC, State of N^w Yark
No. 52-1oo0S58 Suffoik County
Commission Expires March 30, 19,-71 1 k
+ .. � � : , "' ' �� � ���s ,;�,..",.4, �y�t� mss' •' �
-
_
,� � `'��" a:�-rte • � ,f„ R t- 'r '' y..• ���� �+' s- `; �'� �_ 4 b
�Ktlt3:t'. c:t�!^� -.� r--,..�•-•... ,. tg �'s 'w y 't v � �, f �� r
1} y.
1 T
;:1'20:. �••. i- i .`,. � � �; � _ .: r- s
a t/'� '" � ir•+_ a%G'f :`r;:g 1.1-:�cJ - �� ._ "ir - _�7�`�i. a'�
UTNORIZED Ail 1:J 5.y ' *?` #•T r
`4`
77,°
+��� a4•
� C
4
��.
c
�
v 1
,1 a
E aye �n:
7f4is SURVEY? -;t
SECTIOQI 72L4 Ct^+ a .WX K w s ip G
EDUCATION
,�" COPIES OF TAA.
!} i] THE LA, D SU,
Yy T EMlOSSED Sc.:
TO 9E A VAi
•
GUARAP Tt 5 .. j ��` �' . �. � {
jai
ONLY TO TV -
15
Y
15 PREPAk D A r
s TITLE COM ANY, ;G i- ^�5�•, a, - x'�'', -a°s'1 t -+,�':
!ENDING 1r.STiT1MON i
10 THE ASSIGME6S OE a r L
y 1UTION. GUAAANUESc A
TO ADDITIOFAt INSTITUTtDi,S
OWNERS. _ �- ++• - a