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Home My WebLink AboutZ-4814FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at M~,I~. RO~. &. l~ll~e. A~o... Street Map No.. ~1~11; ........ Block No .... ~ .... Lot No. ~1~..l~..~t;!~....~.e~* ........ l~%~t,tr ~._~tt;o for ~to f~t~l.y 5'~eXLt~ conforms substantially to the-'1~S¢~1~1¥~''~1/~~7) la~'r~~l }u~'A~- 1~~. ~..O~...~0&l~l,~..~ .... , 19.~'~. pursuant to which ~~o~~ dated ........ I~.O~ .... ~..~ .... , 19~¢~.., 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 .. P~$;~I~.~;O .O1~..~111,~. ~*'~]2Ltl~...~..c%~..~.v) .~ ......................... The certificate is issued to . .lgS.t~;~ll. I~X~..1~1~ .... O~t~l* ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .PTO~b~l~.t;.:lJ~ .................... UNDERWRITERS CERTIFICATE No.....P~....O.l[.~.8.~..]..P~.. ................................ HOUSE NUMBER...,~O ........ Street ....i~p],o. &~O .................................. 1. ao be~stz~ ee~e in~peetl~ to ~&te / / Building Inspector FORM NO. 8 TOWN OF SOUTHOLD Building Department Town Clerics Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 o'f 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. Dote of any housing cede 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 ......... ..... .gs....J. .... New Building .................... Old or Pre-existing Building ...... ~ .............. Vacant Land ............................ Location Of Property ....... ~j~j~,z..~cl,..&..~;a.F].e..~,ee ............ ~a.~s~,_,;.~u~z.t...~;:,,,E...' .......................... Owner Or Owners Of Property ....... .]~6-..~Fl~J~.-~v.-~e~e~ ................................................................... Subdivision ................ ~ ........................................ Lot No...:y,~... Block No..~Jt,~... House No ...... Permit No ..... ~L~JE ........... Date Of Permit "--Jl~ ........... Applicant .... ~ ....................................................... Health Dept. Approval ...... J~..~e,..~.~.&~ .............. Labor Dept. Approval ....... J~,~e ............................... Underwriters Approval L~ ~ · · ..~ e~..~-~r--:~S~ ................... Planmng Board Approval .... JJeJ~-e .......................... Request For Temporary Certificate ........................................ Final Certificate ...~J[~ .......................... Fee Submitted $ ...,~oJ~) ....................... Construction on above described building a~l~ permit rneet/~ all applicable cos~jand regulgt~/ons. APP"c°n r' ................ Sworn ,o before me this ~,/ ~/-~' [~J'(~' .......... · ~Jl~ day ~,~_.;...~r~j~/~.~.~. / (stamp or seal) ~ ~ Notary P u b Ik.>~~(... ,..~(...:.. z,(,,~.. ~/~ ~ /~'JUDITH T. BOKEN ' ~ij~ Notary Public, State of New York No. 52-0344963 Suffolk County Commission Expires March 30, john f OF'0 NOTE: · = MONUMENT REVISIONS ALDEN W. YOUNG PROFESSIONAL ENGINEER AND SURVEY FOR: V~L WARREN WALDVOGEL & CAROL AT MATTITUCK TOWN of SOUTHOLD SUFFOLK CO., N.Y. SCALE: i. I DATE: = 40' YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK HOWARD W. YOUNG INSURA r~~