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HomeMy WebLinkAboutZ-14405FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date May 16 19.~ THIS CERTIFIES that the building .... O..n?..f..a.m.J_.l.y...ct.w.e. 1..1.i.n.q. ..................... Location of Property ............ 5. 7.1.2.5...bl.a.i.n...R.o.a.d. ................. S. o..u?.h.o. ]:..c) ....... House No. Street Hamlet County Tax Map No. 1000 Section ...0 .6.3 ....... Block .... .0.3. ........Lot . . . .0.Z.9....~ ........ XX XX XX Subdivision ............................... Filed Map No ......... Lot No .............. ACCESSORY HOME OCCUPATION conforms substantially to the Application for l~[fl~3l~ heretofore filed in this office dated Certificate of Occupancy ..... M..ay..1. 2. ......... , 19.8..6 pursuant to which ~t~](~R~tlfiXlXNo ..... Z ], ~ .4.0.5 .......... dated . . . .~.a.y..1.4 .................. 19.8. 6., was issued, and conforms to all of the requirements Art~III, Secl00-30 C(1) {b.) a (c) of the applicable provisions of the law~ The occupancy zor whicli this certificate is issuea is ......... Accessory home occupation--Architect office The certificate is issued to . SAM,U.i~-~$.-.8.T..E.E.~..~..R.C.H..-~..E.N.~.N.? ............................ of theaforesaidbuilding. Tax Roll Burt Lewis Suffolk County Department of Health Approval ........ .N/.R. .............................. UNDERWRITERS CERTIFICATE NO ................ NJ.l~ .............................. 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 OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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. 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 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. 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... ~..~. · .I L .'.~.~. New Building ....... . ,'~.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~.~2~.. ~m.~-~-. .......................................... House No. Street Ham/et Owner or Owners of Property .~.~. J-~(~]~. '.. !~[~ .'.~ .~~--.~ ..... County Tax Map No. 1000 Section ...... ~ ..... Block ...~. ......... 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 and permit meets al,~c,,a~b~e,c~od(~, nd regulations. Applicant., .~.~ ..................... Rev. 10-10-78