HomeMy WebLinkAboutZ-5455FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Cleric's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z5'45..5...... Date ..............Sept....16.... 1973. .
THIS CERTIFIES that the building located at g/S .
villa , . Legs ...... Street
Map No. = ......... Block No. .=....... Lot No. 3=... Qr1f1 t ..T •Y• ...........
conforms substantially to the((X
da e hi
We before a if ate, occupancy
lipril - 23 19. x. pursuant to which o.Z.5455-
dated .........Sept.... 18.... , 1973 . , 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 . V%C. - - -Private -one • family. dwelling ..............................
.................
The certificate is issued to . }.hired. & -Lillian. . 1orklun ......Rwuer.s ............
( owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval prem .existing .................... .
UNDERWRITERS CERTIFICATE No .... pre..existing ................................
HOU'SF NUMBER. .555 ........ Street .. Village .Lane .................................
Building Inspector
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.
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 �ip7
Dote ...��:�..�........�V.�...�.11.
New Building .................... Old or Pre-existing Building .....X ...............Vacant Land ....................,../.....Location Of Property ...LR........(. �•!•CI. (?.....4i.Ft.�. ......
Owner
l
n I 1"
Owner Or Owners Of Property�../-rr-r.J.. P ...f�.l: 1./.Ct..l1.....r'✓/�.<L./.Gl%�..................
Subdivision .................................... .......................Lot No...... Block No...:—:... House No..........
Permit No......S.l....... Date Of Permit .......'........Applicant.`�..........................................................
Health Dept. Approval ........................ `:r .............. Labor Dept. Approval ................................................
Underwriters Approval ...................... `....................... Planning Board Approval .................................
Request For Temporary Certificate ..................................... Final Certificate ..... ..................................
Fee Submitted $ .......... ..Ov..............
Construction on above described building and permit meets all p icable codes and regulations.
Applicant..... ...............................................................
Sworn to before me this '? �%C -� _ ,/�+'?,� �� t 77
...bo.' day of .... . 117 .........
Notary Public.......... FFaL /�....... Countyo�..........�^
FLOYD F. KING, JR.
Notary public State of Now York.
No. 52-7267800 Suffolk County
Term Expires March 30, 1971
(stamp or seal) �57/S S^
I
September 18, 1973
TO WHOM IT MAY CONCERN:
This is to certify that the house located at 465
Village lane, Orient, Town of Southold, New York is
being used as a one (1) family dwelling, with the
condition of the building being good
61qiVEIDIR�
ON
Owners
ILLIAN NORKLUN
St�o�lti
7,1 ��Foliif �!f_ -7141J 1,,L_L6 . 4)A4 - DF -PZ-,00? P?73
FLOYD F. KING, Jk �,
Notary Public State of New York
No. 52-7267800 Suffolk County
Term Expires M"ch 30, 1971y
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UNAUTHORIZED ALTERATION OR ADDI[TOW
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATIE
EDUCATION LAW.
el
COPIES OF THIS SURVEY MAP NOT BEAPINIXG Vi-te Pc4w
THE LAND SU '.VEYC"'S INKED SEAL OR
EMBOSSED SEAL SHAT! W:J BE CONSIDERED,
.5 TO BE A VALID TRUE COPY. !1rTa
GUARANTEES INDICATED HEREON SHMLN"s
ONLY TO THE PE:�,SON FOR WHOM TW- r, 90%ooat at< VAN
IS FREPARED, A',D 0" 1 HiS V.HALF 10, IM
TITLE COMPANY, GOVETUM&NiAL AGEWWJNP
USTED H -f, -'ON, AWO
LENDING INSTITUTION
TO THE ASSIGNEES OF THE LENDING IMMI.
TUTION. GUARANTEES ARE NOT TkA=t4S-
ws&e
Aw
TO ADDITIONAL INSTITUTIONS OIL icy
OWNERS. Si