HomeMy WebLinkAboutZ-10512FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
5outhold, N.Y.
Certificate Of Occupancy
No .... Z.~l).~12 ....... Date ... ~Iune. 3 ...................... 1981.
THIS CERTIFIES that the building ................................................
Location of PropertyHouse .... .4.40.No. ¥~.e emaz~, ltoa~t .&. 2ASstreet. Co~kltn..Rd, .,. .N a tl>t. t;u c l~r~e~ ¥.
County Tax Map No. 1000 Section .... .139 .... Block .... 3 .......... LOt ...40 ............
Subdivision..Gard.en. tte.t, gh t;a ............. Filed Map No. 57.7 ..... Lot No .... 1.0 · &..%$ · ·
~ u:[~ m nra f . . o -f tl d el 1 go
conforms substantially to i?,[~ ~,,=~l~ll~l~[~=..~,lt~',%~&~g~{ ....
.April .23. , 193.7.. pursuant to w~c~.~.~m~ ......... g JO.512 ......
.......... ccupaacy
dated .... ,J.une. 3 ................. 19 8.1., 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 .........
....... .er.x.v.a..~.~..q~..e .-.y.~.~..~ .zy..o..w.~.x.x.x..n~ .........................................
The certificate is issued to .... ~Tack .A...and. S&~a..Vap. R.y,sw~r k.. ....... i ..............
towner, ze_~_e,.e_or..,.~.~.en.,~__
of the aforesaid building.
Suffolk County Department of Health Approval . I~./.R .....................................
UNDERWRITERS CERTIFICATE NO... I~/.R ...........................................
Rev 4/79
Building Inspector
BUILDING DF~OARTr.~NT
TOI',T~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 440 Freeman Road and 245 Conklin Rm~d. M~t. tit.~,~ ~ ¥.
(number & street) (Mhnicipality) '
Subdivision Garden Heights , Map No. 577 Lot(s)~ ~ ~.~
N~me of O%~er(s) Jack A. and sara Van Ryswyk
Occupancy
Admitted by:
R-1 Owner
( type ) ( own er- ten ~',t )
Mrs. Van Ryswyk Accompanied by: Mrs. Van Ryswyk
Key available
Suffolk Co. Tax No. 1.39-3-fl0
Source of request Sara Van Ryswyk
Date 5/6/81
DWET.LING:
Type of construction Wood Framed
Foundation Cement Block Cellar Full
Total rooms, let. Fi 3 2nd. F1 4
#stories
Crawl space
3rd. F1
Bathroom(s) 2
Porch, type
Breezeway
~ype Heat Gas Fired
Fireplace(s) 1
Domestic hotwater
Other
Toilet room(s)
Deck, type
Garage
Warm Air
No. Exits
Yes
Wood Patio, type
Utility room x
Hotwater
Airconditioning
Type heater Gas
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
NONE
Storage, type const.
Guest, type Const.
VIOLATIONS: Housing Code, Chapter 52
,,, Location Description Art. Sec.
Cellar Cellar stairs open one, side T~ 52-27-]%
Stairs Un p~ ~f . c~n~inueus ... II 52-27-B
,/
Remarks: BP8113Z ~)eck - ~175C /0 issued Z6591
Inspected by: ~~~/'~~ Date of Insp.
T~me startS:IS
Curtis W. Horton
6/2/81
end 9:35
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 featu res.
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
$5.00
Date....~./~/~:~/ ..............
New Building ............. Old or Pre-existing Building ... ~ ..... Vacant Land .............
Location of Property.. ~. ~ .0 ............... .~2~..~..~/~/..~.~..~-~ .......... ~/~c.~.~. ~ .~.~ .~/.~,~_
House No, Street Ham/et
Owner or Owners of Property ...~...~.c~..~.,..~.....~..S .~..~.~... ~..~..k~...~..~,/..~.. ~.~.~..~_ ...............
CountyTax Map No. 1000Section. ?.~.~. ......... Block ~.~....~.. ........ Lo~...~.~
Subdivision..~..~.~-.c~. ?.,.d...~..~./i~.~..~. ........... Filed Map No.O(~/,..~?.?...Lot ,o../.@ .+. ~./ .......
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 $...~ ..........................
~onstruction on above ~e~ribed building and~ermit meets all applicable codes and regulations. 'l~ ' ~ ,>. I
~. 10-10-78
V~i T'UVL ~
L/cen.ed L~i~d