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HomeMy WebLinkAboutZ-14722FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED PRE C.O. Certificate Of Occupancy No. Z14722 Date July 29 19.8.6 THIS CERTIFIES that the building PRIVATE ONE FAMILY DWELLING Location of Property 11365 SOUND AVENUE MATTITUCK h~ ~oi ....................... '~'t,:ebi ....................... h~ie~ County Tax Map No. 1000 Section . .1.4.1. ....... Block 03 .Lot 0 0 6.2 Subdivision ............................... Filed Map No ......... Lot No .............. ~ R~QUIRF~4ENTS FOR A ONE FAMILY DWELLING BUILT PRIOR TO conforms substantially to me i~0m~l~yzX~__a~xRahvnl~R~hxa~~xt~x~7~.~x APRIL 23 19 .5.7. pursuant to wh~hRl~-I'F'JGg'~l~',Ol~' OCCUPANCY ...................... aauuaw~.~an r~o ........... 4~Zl.4;222... dated .... .J.u.lx..2.9 ................ 19..8.6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... P.~$.v.a.t.e..one family dwellinq~ frame 1 car garage and accessory frame building. The certificate is issued to TERRENCE P. O ' SHEA ................ ..... /o;;,,,',;, .................... of the aforesaid building. Suffolk County Department of Health Approval .N.[ .R. UNDERWRITERS CERTIFICATE NO. . . N/R UPDATE OF PRE C.O. 9Z9745 Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANC" Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ 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 featu res. 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p=operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 $15.00 Date ....... 2/.~...~ .~. ~. ......... NewC°nstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........ ............... ............ House No. Street Hamlet Owner or Owners of Property /~z4~__~__ . .~,.. (~t .~-/,~,~,,. County Tax Map No. 1000 Section .... ~. ~/~. ....... Block ....... .O.~. .... Lot...~..~.~.: ..=~. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building~t meets all applicable ~~aations. Applicant V~ /,.'~). ~.~ ........ Rev. 10-10-78