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HomeMy WebLinkAboutZ-7291NO. · TOWN OF $OUTHOLD BUH.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z7~9.1 ....... Date ........... 0et~.. ~ .~. ........, 19. ~6 THIS CERTIFIES that the building located at . .[i/.8. Na~t~. Roa4 ........... Street Map No... ~ ....... Block No... ~ ..... Lot No.. ~.. ~i~ ................... conforms substantially to th~[~~~~~~ ~~e d~l~. ~.,fO,., .Ap, 23 .... , 19.~. p~suant to whieh~~~~q' dated ............ ~.~... ~., 197&., was issued, ~d conforms to ~ of ~e reql~r~ ments of the applicable pro~sions of the law. The occup~ey for which ~s ee~ificate ~ issued is . Private..o~e. ~ily. d~l 1 ~g.. &. P~lvate..ga~e ................. The certificate is issued to .~h~. ~..~,,~el.. ~ell .... ~ers .............. (owner, lessee or ten,t) of the afores~d building. S~o~ County Department of Health Approval pre,..exis~g ..................... UNDERWRITERS CERTIFICATE No. pre,existing .............................. HOUSE NUMBER ...~92.0 ..... Street .. ~. R~a~ .... 0rle~ .................. FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office 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 Inspector 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 installations, a certificate of Code compliance from the Architect or E, ngineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date October 13, 1976 New Building ................ Addition ................ Old or Pre-existing Building ....X.. .......... Vacant Land .............. Location Of Property South Side of Main Road, Orient, New York Owner Or Owners Of Property ...... .A...~.h~.u.~.~.~:.~.?.~.~.?..~.e.~.[..~...~.a..~...d....~...n.?...a.?~.e.`]:..~¥.~:...?.~5.~.~;....~. ...... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ...... ~ .... R.,...~.~fi.q~x...~..s. cJ.%..~..°.~ ......... Arthur and Annabel Tyrrell Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ........... ~ ............................ Notary Public .........~.kl .~.f..Q ~..k.. .......... County Fee Submitted $ .... ~..,.Q.0. ....................... Construction on above described buil~et/~all applicable codes and regulations. T.. p. '~..dson, ?.sq., for grthur a~d Annabel Sworn to before me this Tyrre 11 ~ ~3th day of Qctober, 1976 (stamp or seal) ....................................................... ,~OTARY P'.$.!C St~ of N~w