Loading...
HomeMy WebLinkAboutZ-15425FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED PRE C.O. Certificate Of Occupancy THIS CERTIFIES that the building .... p.r.i.y .a.t.e..o..n.e..f.a..m.i.l.y...d.w.e. 1..1 .i.n.g... .......... Location of Property ..... 18.110. To.~n. Haanbor..Lane..&. 4 0..Tel:r2;..L~gta.e... ~9.u.t.h. 9.1.a.-.' House No. Street Hamlet County Tax Map No. 1000 Section . 6.5 ........ Block .. ~-. ........... Lot .... 3. ..... ~ ...... Subdivision ...~.'..O.y.e.~.L.o..n ................. Fi]ed Map No ......... Lot No. 17:-~-.~-: 3. 9 .... Requirements for a one family dwelling built prior conforms substantially to the 2~01t~XI:~/~'K]~d~~~~~~ ~ C~ r ~ i~i~_ _t__e~ _ _o_ f.. 0 C c up an cy tp...Ap.r.i. 1...2.3 .......... 1,9 .5.7. pursuant to wmcn ODlI~llg~l~ r~o ......... Z 15.4.25 ...... dated . .N.o.y.e.m.b.e..r..2.5. ............. 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 ......... .... ?.r.:[.v..a.t.e., o..n.e..~.a..m~.L:Z..d.w.e.% .~ .~.n~ .. .......................................... The certificate is issued to .. hl.b. 9.r.~...H:..a.n..d..F.r.a..n.c.e.s...CZ..S.~9.n.~' .................... (owner, ~K~I{ of the aforesaid building. Suffolk County Department of Health Approval ........... p.~.e..e.¥~.s.L.~.n, g ................. UNDERWRITERS CERTIFICATE NO ................... p.~.e..e.¥~.s.~.~..rig ................. Update of Pre C.O. #Z6447 Herbert & Ruth Rosenberg 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 A. 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 properW 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 2. Certificate of occupancy on pre-existing dwelling $15 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 / 5.~Updated C.O. $15.00 Date.. z'~.~J..--..~..~..-~.' .~ ....... NewC°nst~uction ...... O~d or Pre-existing Building ~ ......... Vacant Land ............. Location of ProperW .'.Z: .O..~. N~.. ~i/./~l. ~ v~ ~ ~. ~:~....~..~-. 4~'/~.~/.../~ ./~./y/.~....,~.~..~.'.~.4-/.d G../-) House No. Street Ham/et Owner or Owners of Property ./~..~. ~../c..~. ~,~-.'./~. ,.. ~1¢4~'D.. ~'.~.~f~V.~..,,~...~.~..~. ~.~..~ j:~ ........ County Tax Map No. 1000 Section %/: ./P...~.c~.T'..o.~.... 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 all applicab~J~_odes and regulations. Applicant ~.~.~..~.~'. ~ '- R-,. o- o-7e ? /,