HomeMy WebLinkAboutZ-9565FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No...Z.9fi. 6..5 .......... Date .................... J un~ .22., .... 19.7.9
THIS CERTIFIES that the building ................................................
Location of Property ~s2e~5o~ -l~a I n..St ree~-&. 7.05. F~re~' · ~-$. nee*,.. New.. S u ~.f~ I~r~/e~
County Tax Map No. 1000 Section ...I. L 7 ...... Block ..... 08 ........ Lot . pe.~'. 04- · [ 4 ....
Subdivision ......... XXZX ......... X ....... Filed Map No ..... Xxx. Lot No .... K.X-)~ ......
THE REQUIREME~NT~ ~'.QR .~ MLLY.DWE Ltl EUIII_T _NT R OhlE FAM LY W LL NG RRIOR
TO
conforms
substantially to ~kex~`R~Rr~;~rx~i~Ar~x~e~Rtx~t~~9~~"~~`~`~`~`~`~`~`~`~`~`~`~`
CERTI F. IC.A]~E. OF .OCCUPANCY
..... fip.~. [ I. Z3, ..... ,1957. pursuant to wliicn ~~ No ..... Z95~5 ...........
dated ............. ,I.u ~ o. 2.2, ..... 19~9., 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.R I YA.T.E. O~E . FAMI.[-Y. D.~E [-L.I.NG..(~EA $OgA k ) .....................
The certificate is issued to ..... ~/[ [.[..lAM. E....&. PF~GGY. ~8.H ITE ..........................
of the aforesaid building.
Suffolk County Department of Health Approval ... ?.R.E.-. E..X.I .S.T. [ .N.(3,. ........................
UNDERWRITERS CERTIFICATE NO ........... ?.R.~.-..E.XJ.S.T. [ .~.G .........................
Building Inspector
Rev 4/79
Location
Subdivision
Na~ne of Owner(s)
Occupancy R- I
(type)
Adxnitted by: ~ I ~
Key available__
Source Of request
17245 Main Street & 705
(number & street)
×××
BUILDING DEPARTF~NT
TOV~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
First Street, New
Wi lam
Peggy White
Map No.
E. & Peggy White
Suffolk, New York
(Mu~aicipality)
XXX Lot(s) xxx
Unoccupied
(owner-tenant)
Accompanied by: self
Suffolk Co. T~ No.lOOO-II7-OS-part
Date June 20, 979
D%fELLING~
~e of construction Wood
Foundation cement block piers
Total rooms, 1st. Fi
Bathroom(s) one
Porch, type open
Breezeway xxxx
~y!oe Heat None
Fireplace(s) xxxx
Domestic hotwater
Other
ACCESSORY STRUCTL~RES: NONE
Garage, type const.
Swimming pool
Other
five
Deck, type
Garage xxxx
'Warm Air xxxx
No. Exits one
yes
#stories
Cellar xxxx Crawl space
2nd. F1 xxxx 3rd. F1
Toilet room(s) xxxx
xxxx Patio,
Utility room
Hotwater xxxx
Airconditioninf
Type heater electric
Storage, type const.
Guest, type const.
one
XXX
XXXX
type.xxxx'
yes
XXXX
VIOLATIONS:
Location I
BACK BEDROOM
BATHROOM FLOOR
Housing Code, Chapter 52
Description
hole in ceiling
OUTSIDE shingles
tile floor bad
broken sidewall
only one exit
no heat
Art.
.I
I
See.
52-32-C
52-32-D
52-31-B
52-28-C
. 52-53-A
Remarks: Summer Occupancy Only
Curtis Hort66
Date of Insp. June 22, 1979
Time start I:15 amend 11:40 am
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 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.
B. 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. /~,~
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date..(,~CI.(~....~...O.. ,~,.
New Building ............. Old or Pre-existing Building .... ~. ...... Vacant Land .............
Location of PropertyHouse'l~"J'O"'No. C~z~. .. [~O~['.C)..q-. . .~. . .L~..~[ ..~.~.C~C;.~-~. . .eet ('~'L~'~%(21~'~'
Owner or Owners of Property . .~..~1.\ / [ ~ F'~...~..c-t...~.C~...c~-~..~,~ ~.-~ ...........
County Tax Map No. 1000 Section ..... /../~/'. ..... Block ...... ~.. ...... Lot..../..~.. ........
Subdivision ............. ~.. ................. Map No .... .~. ........ Lot No ..... ~ ......
Permit No ........... Date of Permit .......... Applicant ..~"~-'c'~ 1%. . ., .........
equest for Temporary Certificate ..................... Final Certificate .... ~/~. ...............
Fee Submittod $ .~. ~ ......................
Construction on above described building and per~t-~eets all applicable codes and regulations.
Applicant ....... \~' ..r,~..~,t~. '. ..................