HomeMy WebLinkAboutZ-14824FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Sou(hold, N.Y.
Certificate Of Occupancy
No. Z14824 Date August 22 19 86
THIS CERTIFIES that the building ..... O..n.e..f.a.m..i.l~..d..w.e.l.l.i..n.g.. ...................·
Location of Property .... .8.0.0...S.~.r.o.h..s.o.n..R..o.a.d.: ............ C.u..t?.h.o.g'. ~.e ...............
House No. Street Hamle~
County Tax Map No. 1000 Section . .1. 0..3 ....... Block .... 1..0 ......... Lot .... 2. 3. ..........
Subdivision ............................... Filed Map No ......... Lot No ..............
· R. equ~re.me,$ts, fQ.r ~ privat_e., on~e-f.~am, il!~ ,dwel_lin~ .b.u. il~t~ prior, to
conforms suostan[lany [o me
C e r t i f i c q ~ ~ ~oo .f.. _o..c..c_u.p..a.~ ~ y
·.. AD:il..23 ......... 19 ,5.7. pursuant to wmcn-~Ramm%,.x~mm mo...z..1.4.8.2.4. ............
dated .A. ug~.St.. 2.2 ............... 19 ~.6., was issued, and conforms to aU of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
..... One. ~a~il.Y..dw~i~g.;..&. b~ach, kause ........................... ::'. .......
The certificate is issued to ...... .L. QL..A..S.T.A..C.K .........................................
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval ........ ; ?../.~ .............................
UNDERWRITERS CERTIFICATE NO .................. ~./.A .............................
B.P.#3698 11/2/68
B.P.#9234 5/6/77
Addition and alteration C.O. #Z2995
Pool
Building Inspector
Rev. 1/81
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STATE OF NEW YORK )
) SS.:
COUNTY OF SUFFOLK )
RUDOLPH H. BRUER, being duly sworn, deposes and says:
THAT he is the attorney and agent for Lola Stack, the owner of
certain premises at Cutchogue, N.Y., designated on the Suffolk County
Tax Map as: District 1000, Section 103, Block 10, Lot 23;
THAT your deponent has had numerous conversations with Lola Stack
regarding this property and the structures thereon; that Lola Stack
has stated to your deponent, of her personal knowledge, that the
structures shown on the attached survey dated July 12, 1961, made by
Otto W. Van Tuyl & Son, were built prior to April 23, 1957;
THAT your deponent can state on information and belief that
certain changes and additions have been made to said premises which
are covered under (1) Certificate of Occupancy #Z2995, dated 3/3/68,
and (2) Certificate of Occupancy #Z7840, dated 8/12/77; and that,
other than as covered by the above Certificates of Occupancy, there
have been no further changes to said structures, except normal
maintenance, since prior to April 23, 1957.
Sworn to before me this
/~day of August, 1986.
y Public
~OTARY PUBLIC, State of New
No. 52-4655242, Suffolk
Commission Expires March 30, 19
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. 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 unu~Jal
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 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 safew inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00 /
2. Certificate of occupancv on pre-existing dwelling / land use --Pre-Existing C.0. $15,00
3. Copy of certificate of occupancy $1.00
Vacant land ~.0. $ 5,00
New Building ............. Old or Pre-existing Building .~..'.~. ...... Vacant Land ........ ~.~...
Location of Property ..~, .... ~~....~./...~...~~ ....
House No. //~L/x~'- . /) Stree~ Hamlet
Owner or Owners of Property .... ~ .~.. ~-~ .~._.~. ~. y .... ~.~-. .............................
County Tax ,v, ap ,o. ,000 Sec, on ... B,oc ...... /..o ...... ........
Subdivision ................................. Filed Map No ......... ~, ot No ..............
Permit No ........... Date of Permit .......... Applicant. _~..'..~..~.,.~ .........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ...................... Final Certificate .
FeeSubmitted$..[.~-.,'..~......~.'..~.!~.~. .....
/
Construction on above described building andj3er.,rnit meets all applicable cod.e~ and regulations.
Applicant .~.~., .~.~.. ~. ,~,.~.....~,, .~ .~.~-- ...............
Re~, 10-10-78