HomeMy WebLinkAboutZ-10621FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z10621
No ..................
THIS CERTIFIES that the building ................................................
28735 Plain Road, Cutchogua, ~le~ ~ork
Location of Property/2/&;s; )V'o[ ....................... k~/e~t' ....................... /:/~1~
County Tax Map No. 1000 Section .... .1.07. .... Block 05 .Lot 22
Subdivision ............................... Filed Map No ......... Lot No ..............
Requirement;s for an Office Building Built Prior
conforms substantially to the
Cert;ifica~e of OccupancYzl
..... A. ~r?3..~.? ........ 1¢~.. pursuant to whioh',m~,m~,'~'~r~: ............... .o.6.~. !.
dated August; 7 19. 81
.............................. , 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 .........
...................... o.r..r~.e.:..~.uyy. ~..x.~.g. ........................................
The certificate is issued to Town of Southold
..................... /o¥.~;~1~Xat a x ...................
of the aforesaid building.
Suffolk County Department of Health Approval ....N./.R. ...................................
UNDERWRITERS CERTIFICATE NO. N/R
Building Inspector
Rev. 1/81
o
o
0'001
0