HomeMy WebLinkAboutZ-4795FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z4%9S...... Date ............ ®ept ...1...... 19.'j2.
THIS CERTIFIES that the building located at .gtg .Mason - DIP . . • . . . Street
Map No. ... xx ...... Block No. . xx ...... Lot No.. X= ... CntChose .. R oy • .......
conforms substantially to the a en t using code
prior to April 23 Cert iC*tof occcu�pancy
jimacm . • • . .. • .............. . 19.57 . pursuant to which am41m[�� o.
dated ......... Sept.. 1......, 19.72.1 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 ... Private—one. family .dwelling .....................................
The certificate is issued to ...William. do .Juli& .Mil,ler • ... Uwnera ...............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . p8q-existing ....................
UNDERWRITERS CERTIFICATE No ... pre„exliting.................................
HOUSE NUMBER... 1.570 ..... Street ..... Mason.Dr . • ............................... .
.14-0 .......... .
Building Inspector
HOUSING CODE INSPECTION
September 1, 1972
1570 Mason Drive
East Cutchogue, New York
Tax Roll: William Miller
Occupant: Gianoni
Upon request of the Southold Town Building
Department I made inspection of this one story
frame dwelling, beginning at approximately 2:45
p.m. I found no violations of Local Law #1,
Housing Code, Town of Southold. I completed
inspection at approximately 3:00 p.m.
t
R pectfully u itted,
Edward Hindermann
Inspector
EH:tle
FORM NO. 8
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 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 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 Datet..l2
.g
...........
..........
New Building .................... Old or Pre-existing Building ..... ..................... Vacant Land ............................
Location Of Property ... F /8 Mas.ori Drive %1�t Cutebosue )... No. Y. ..........................
... ..r.... ................ ....
Owner Or Owners Of Property
William N. andr.ul.ia N. Miller
................................................................................................
Subdivision................................................................Lot No. Block No. . 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 X
.................................................................................
Fee Submitted $ , ofd. too .......................
Construction on above described building r codes and regulations.
Applicant , .. .........................................
Sworn to before me this ways
l.....da of .Augua s...�9�.....................
IWiO111
Notary Public
.................................... County
on+Qtar� bli
1
(stamp or seal)
MARY LOU DOROSKI
N07ARY PUBLIC, State of New York
No. 52-1000858 Suffolk CO"1973
Commission Expires March 30,