HomeMy WebLinkAboutZ-7850FORM NO. ·
TOWN OF SOUTHOLD
BUILDING DEPARTMF,,NT
Town Clerk's Office
$outhold, N. Y.
Certificnte Of Occupnncy
No. Z78.. .....
Date ' ...A~l~ust. L~, ............ , 19..7.?
THIS CERTIFIES that the building located at~.S. Ma.~.~. Road ............. Street
Map No.. X~X ....... Block No..X~ ..... Lot No ..... De~c. .......................
conforms substantially to tl~ ~ - ~ d H _Code
built before
· ecupaney
dated ........ Ap-r.:[,.'~ .2.~..., 19. ~'7' pursuant to
dated .. &u~mt,. ~.~ ........ , 197.7. ., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is Pr.~vate .one..f. am~l,y .dwetlir~. weth. aeoeesory, bu~ldtngm.,..(o~ .garage
o~ storage b~lding)
~e certificate is issued to .. A~olph ~. 14,..Wes~rl~ ............................
(owner, ~ ~ ~)
of the aforesaid building.
Suffolk County Department of Health Approval .. P~e-Existing ...................
UNDERWRITERS CERTIFICATE No ....... Pre.-~lc;~B.~g ........................
HOUSE NUMBER .~170D ....... Street .. l~alm .Roa~[~. Pec.cnic, .N,. ~, .........
Building Inspector
HOUSING CODE INSPECTION
August 2~ 1977
#41700 Main Road R-1
Peconic, N.Y.
Tax Roll: Adolph & M. Westerlund
Occupied: Owner
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy, I made an inspection of the buildings on this prop-
erty. I was admitted to dwelling by Mrs. Westerlund and began this
inspection at approximately 9:00 A.M.
The dwelling is a one-story wood framed structure constructed
on a concrete block foundation. Ground floor contains kitchen,
dining room, living room, bedroom and a full bathroom. Second
floor is a completed attic that contains two rooms for sleeping.
Heat is furnished to all rooms on first floor from a forced warm
air furnace located in full cellar. Accessory structure include
a one and one-half car garage and a small storage building. These
buildings are of wood frame construction.
I found no violations of the Housing Code, Chapter 52,
Town of Southold, New York.
Inspection completed at appro~i$1ately 9:15 A.M.
~:(~ .~a~G ~lncre~l~uann
Building Inspector
EH:med
FORM NO. S
TOWN OF SOUTHOLD
Building Department
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 triplicate to the Building
Inspector with the following; for new buildings or new use:
I. 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 disposel--(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 Engineer 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 o~ 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. Copyofcertificateofoccupancy $1.00 ~ ~ /
D te . .................. .7.2...
New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property ......-~./~......~.,~/~...../.~.~....~../~......; ........... ..~....~,~.%.~.~.,,4~./..~, ..................................
Owner Or Owners Of Property .....~../~..~..~,..~../~.....~..~.....~..~ .'~,~?,~....¢,2. x~.....'. ...........................
Subdivision ............. ~ .............................................. Lot N~.'...;. Block No ............. House No.~ ........
Permit No ..................... Date Of Permit ......... ~ ....... Applicant
Health Dept. Approval ....... ..~../.~.~,---- ..................... Labor Dept."Appr°val'"'" ..~....,~...~....;'''''''''''''''''''''''''''''''-'-''''' '"'"'""'-';;'" '"'"'"'"'"'"'"'""'
Underwriters Approval ........ ..~......./...~..-r ............. Planning Board Approval .... ...'~..././...'~.... ...................
Request For Temporary Certificate ........................................ Final Certificate~ ......................................
Fee Submitted $ ...~......~.'~... .....................
Construction on above described building and. permit meets all, applicable codes and regulations.
A cant ~ ~' ..~.., ~ ....................................
Sworn ,o before me this ~
................ day of ............................................ (stamp or seal)
Notary Public .................................... County C/. 0,~:~(t'