HomeMy WebLinkAboutZ-9796FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
1~. "~..Z~)'.~6 ........ Date ...... ~.~.O.~1~).~..~.9 .............. 19.79
THIS CERTIFIES that the building ................................................
Location of Property .... .8/.$...1~.15'!3..~r~4..RO.8=~. ..................... .~.~1~.~,~,15.
House No. Street Hamlet
County Tax Map No. 1000 Section .... 0~5 .... Block .... 02 ......... Lot ..... .O.Q~ ........
Subdivision ............................... Filed Map No ......... Lot No ..............
requirementa for a one family dwelling built prior to
conforms substantially to the ~,~eti~-~tkl- ~'6~, l~4'al-~,l~-a~
Certificate of
..... April .23 ....... ,19 ~.Tpursuant to which l~l~m~ ~,i~;.
0~ctm
dated ... Ilecellll:~er..1.~ ........... 19..7.~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 .........
.................. P~£v.e~.~..One. ~.~.!y..]~.e!.l.~ng ..............................
The certificate is issued to ................ 1~/$8iJ.],8. ~ .lrI~!rl~l ...................
of the aforesaid building.
Suffolk County Department of Health Approval ........... .~..~. ...........................
UNDERWRITERS CERTIFICATE NO. ~'~'~"~~~ ~::.../ ..~.....~...
Building Inspector
Rev 4/79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ~/~ ~T~/-C~/q,~
(number & street)
Subdivision ~-' Map No.
Name of Owner(s)
Occupancy /~-- /
(type)
Admitted by:
(Municipality) Lot(s)
(owner-ten~nt)
Accompanied by:
Key available
Source of request
Suffolk Co. Tax No.
Date ~C~
DWELLING:
Type of construction ~Z)~O '~,,'-d~,,u,'~- #stories
Foundation ------- ? Cellar '~-- Crawl space
Total rooms, let. F1 ~-~K~H- 2nd. F1 3rd. F1
~/~ Toilet room(s)
Bathroom(s) .j~
Porch, type
Breezeway
Type Heat
Fireplace(s)
Domestic hotwater
Other
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Deck, type
Garage
~Warm Air
No. Exits
Patio, type.__
Utility room
Hotwater
Airconditioning
Type heater
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description
Art. Sec.
Inspected byJ'~-~,'~.,~' ("~// Date of Insp. ~c f~' 7?
~?f~,,l/F~_ ;nZ.....,,. Time start end
Co
FORM NO. 6
' TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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 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 peoperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 or land use
3. Copy of certificate of occupancy $1.00
New Building ............. Old or Pre-existing Building ... ~ ...... Vacant Land ..., .----". .......
Location of Property ,/~.f~ Z ............. ~.:c,/.~.~ ..............
House No. Street Ham/et
Owner or Owners of Property ,~(~,~./--Y'.~../.~iZ./~...~:.. ~/~..../~.~.~_~7~'~.. .......................
County Tax Map No. 1000 Section ...... ~ ....... Block .. 72.. .......... 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 describ~e~ building and permit meets all applicable codes and regulations.
~/Applicant ....................................................
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