HomeMy WebLinkAboutZ-4610FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. $461 Q ..... Date ...........>p .. 11t ...... , 19.72-
THIS
9.e2.THIS CERTIFIES that the building located at Sound. �oad ................ Street
Map No.. xz ........ Block No.... alb .... Lot No.. appy ..... @reimport .. N *Y...... .
conforms substantially to the &&Uv) JU.A*Aem1,17 gW&h19L +W „ AjQQ
brtoro 19 .. g pursuant to ftTC14 ".".1cy
April 23.. .7 2441 p. .
dated ........ April" Vv • - , 19.72., 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 ene. fesiily • dwolling......................................
The certificate is issued to ..1joMaz. & Viza. ...... Owners .. to .ace. Egish & Wife
(owner, lessee or tenant) purchasers
of the aforesaid building.
Suffolk County Department of Health Approval ... Pr6...,w!4XJA JXg...................
UNDERWRITERS CERTIFICATE No ....... t ..........................................
HOUSF NUMBER.. 40 ....... Street .... Sound- Rena.....Oroenport................. .
.................................................................................
NOT31 Exceptions to housing Godot
Ae electric switch at enteraneo Building Inspector
umeoTered electric outlet boat
exposed ('uncovered) fuel line to heater
chimey flashing leaking.
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 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.
Date .,.April , 1972
... 12 ..............................
New Building .................... Old or Pre-existing Building .......X.................. Vacant Land ............................
Location Of Property ... $tR..Attached Contract Face Page
......................................................................................................................
Owner Or Owners Of Property ....Norman H and Vina F. Morrow
.......................................................................................................
Subdivision................................................................Lot No............. Block No............. House No.............
Permit No. Date Of Permit Applicant George A. & Gertrude K. Egis..
.................... .................... ..................................X ............. h
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ................:.............
Fee Submitted $ .....5 5.00
............................
Construction on above described buildin permit me ll a le codes and regulations.
Applicant a� GleiEiu 1C..'r.'.'S ...
q Eq�s i
Sworn to before me this Cont act Vendeaa
12th day of .... April 1972 (stamp or seal)
......... ..................
Notary Pub
Suffolk County
.............................. .. Cour c
C
GEOR E C. STANKEVICH
NOTARY PUBLIC, State of New York
No. 30-3807858
Qualified in Nassau County
Certified in Suffolk, Qusens, tungh
and New York Counties
Commission Expires March 30. Ig7a
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