HomeMy WebLinkAboutZ-10517FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building ................................................
Location of Property/:/3ds~ h/ol ' 3.7.5. ~'l.rl ~. R.o.a~, ........ Sou ~;kald ~. 3[e,~. X. aelt ........
Street Ham/et
County Tax Map No. ]000 Section .... ~.4 ..... Block ... 9 ........... Lot ..... 1.1.. &..12. ....
Subdivision ............................... Filed Map No ......... Lot No ..............
~o
· _Occupancy 1 ....
dated . ,~e..~., ................... 1~l. ~ 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 .........
(owner,'qe~ee' e'i-"te~eh-"t'}'
of the aforesaid building.
Suffolk County Department of Health Approval ... N/R ....................................
UNDERWRITERS CERTIFICATE NO...~./. R. ............................................
Rev 4/79
BUILDIh~G DEPOT"tENT
TO%'.~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 375 Pine Road~
(number & street)
Subdivision Map No.
Name of O~mer(s) Margaret C. Wheeler
(MuflicipalY~)
Lot(s)
Occupancy R-1
(type)
Admitted by: Self
Unoccupied
(owner-ten~-~t)
Accompanied by: Self
Key available Albertson Realty Suffolk Co. Tax No. 54-9~11 & 12
Source of request William H. Prfce, Jr. Esq. Date May 19, 1981
DYfELLING:
Type of construction
Foundation Cement Block
Total rooms, 1st. F1 4
Bathroom(s) 1
Porch, type Wnnd
Breezeway X
~,pe Heat o~] Fired
Fireplace(s) 1
Domestic hotwater Yes
Other
Wood framed
Cellar
2nd. F1
Deck,
Garage 1 Car
Warm Air
No. Exits
Type heater
#sTories0ne
Crawl space
5rd. F1
Toilet room(s)
type. Patio, type
Utility room
Airconditioning
Tankless
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
NONE
Storage, type const. "
Guest, type Const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
C~]l~r Cellarwav ~tt~n III' 52-30-A
OUtside Wood gl]tter~ ~ott.~n III 52 30 C
Rear Steps Wooded r~ ~t~n~ n~ ~?~ing III 52 20 A
Remarks:
.Inspected by:
(~i. ~. ~.~-'- Date of Insp. 6/4/81
Curtis W. Horton T~me start 11:4~ end 12:10
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
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 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.
B. For existing buildings (prior to April 19§7), 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 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 informa-
tion required to prepare a certificate.
C. 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
May 19, 1981
Date ..........................
XX
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
~-~ Pine Road Southold
Location of Property .... ~. ~ .~. ..........................................................
House No. Street Ham/et
Owner or Owners of Property Margaret C, Wheeler
County TaxMapNo. 10OOSection 054 Block 09 Lot., 011 & 012
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....~.X. ................
Fee Subm tted $ ...........
Construction on above described building and permit meets~plic~abl_e~s and regulations.
App;icant .......
WILLIAM H. PRICE, JR., ESQ. Attorney/Agent~\~,~
Rev. 10-10-78 for Margaret C. Wheeler
Iv.
;:,) ';
,:) ,,