Loading...
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'