HomeMy WebLinkAboutZ-11643TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, NEW YORK
CERTIFICATE OF OCCUPANCY
N O A%C-6) N F4~I% M-I {K~_~- {mR-t~ t~PIS ~S
No. Z11643 4/28/83
THIS IS TO CERTIFY that the
/--/ Land
/ / Building(s)
]i! Use(~
located at 795 Minnehaha Boulevard
Southold
Street Hamlet
shown on County tax map as District 1000, Section 087 , Block 03
Lot 14. 1 , does~R~conform to the present Building Zone Code of the
Town of Southold for the following reasons:
a one-family dwelling use 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 ~;~-¥conforming /--/Land /--/Building(s)
/--_X/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: a one--family dwelling.
The Certificate is issued to HUGH C. & JOAN R. NEWMAN
(owner, i-e-s~%~-o-r' ~e-ffarrrt)
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS 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 if 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.
~'L Building Lnspe ctor
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 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 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 informa-
tion required to prepare a certificate. ;
C. Fees:
1. Certificate of occupancy $5.00 c~ ~'//~5
2. Certificate of occupancy on pre-existing dwelling land use ~/ .00
3. Copy of certificate of occupancy $1.00
,..
New Building ........... .,. Old or Pre-existing Building(X). _.'~ .- =/Vacant Land '. ...........
Owner or Owners of P~:~;rtt'..~'.~.. ~ .,-~ ~:~.~.
....... .... .........
Subdivision ................................. Filed MapNo...; ....... LotNo.].~ ..........
Permit No. Date of Permit .......... Applicant ....................
Hea~th De~t. A~roval ........................ kabor ~ept. Approval .........................
Underwriters Approval ........................ Planning Board Approval ....... ~.~ . . . ..~
Request for Temporary Certificate ................. ~nal Certificate ....
Fee Submitted S. ~.~.~ ~ ............... / / / ~,~lS~q '~,~
~onstruction on above described building and pe~ ~e~~cabl~o~s and regulat,~ns.
P. 0. Box 38
GARY FLANNER OLSEN
COUNSELLOR AT LAW
AFFIDAVIT
Re: Newman to McKenna
American Title Insurance Co.
Title #07-104-504
STATE OF NEW YORK)
SS:
COUNTY OF SUFFOLK)
Hugh C. Newmn, being duly sworn, deposes and states as follows:
That I am theowner of the house described on Suffolk County Tax Map
as 1000-87-3~1~'~. That said house was constructed prior to the
issuance of Certificate of Occupancy and has been used for many years
and is suitable for single residential purposes in my opinion.
Yugbf'C. Newman/
Sworn to befor~/~his 14th
day of April,/1983 /
GARY FLANNER OLSEN
Notary Public, Sta~e of New York
No. 52-295~BOO
Qualified in Suffolk Cotmty
Commission E~pires ~dl~,rch