HomeMy WebLinkAboutZ-11405FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
O(fice of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date December 30 19~.
THIS CERTIFIES that the buildingS... I ~.) ..........................................
Ninth Street
Location of Property . .3 .2.2.5. ........................................ qrj..e.e.n.p.o..~.t .......
House No. Street Ham/et
County Tax Map No. lO00 Section . . .0.4,8. ...... Block ,0..3 ............ Lot . ...0.2.8. ..........
Subdivision ... 9.r.e.e..np.q~. ~..D.~J:Y .SPS..~..a?.k..Filed Map No. 3..6.9 ..... Lot No...4.. ..........
Requirements for a private one-family dwelling built prior to
conforms substantially to the Appl~b~ahorr "for BuffdS~ Perrrdt- ho'toro'fore -ftledr 'hr tkir ~ffrce-duterl
Certificate of Occupancy
·.. 6 p r ~.1.. 2. .3 ......... , 19 5. .7. pursuant to which Bui'ki-irr~FelTn~ No .... Z. 1 ] .4.0.5. ...........
dated .... D. 9 9 ~.m.b..e ?..5 0. ........... 19~ 2.. , was issued, and conforms to all o f the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
...~. p.~.~, v ~.~., ~.n?.-.~. ~. ~.~.?.. ¢ ?.~.~. ~_.~.n.~...a.~.d..~? ?.?.~. ?.ry..~..~y.?~.: ................
The certificate is issued to .... EE.~. Cy..B., . .&..S. $.D.I.~ .~.~.L.~0. ~ ............................
(owner, le~ee-o~
of the aforesaid building.
Suffolk County Department of Health Approval . . .n.qC...a pp. lfi..c.a.b.~.e. .......................
UNDERWRITERS CERTIFICATE NO .......... .n.q'q..a p.p. 1..5_ .c.a.b. 1. e. .......................
Building Inspector
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(MuniCipality)
(n~um~ber & street~
Subdivis£or/~/.~7~l,q(/ ~ Map NO-
N~e or Owner(s) ~
/
. (type) [owneW~}
A~itted by~~// Accomp~ied by:
Key available ~ Suffolk Co.
Source of request ~M~ ~~/6 ,~ Date
DWELLING:
Type of construction
Cellar .
Total rooms, 1st. Fl~5---- 2nd. F1
#stories
Crawl space~
3rd. F1
Bathroom(s) ~-f~ Toilet room(s) ~
Porch, type~~ Deck, type Patio,
Breezeway/ - -
Type Heat~-~/
Fireplace(s) - -
Domestic hotwater
Other
type
Garage. Utility room
Warm Air--~~Hotwatero~/7~
No. Exits ?~ Airconditioning.
Type heater
ACCESSORY STRUCTURES
Swimming pool
Other
Storage, type const. Z~~r~
Guest, type const. .
VIOLATIONS: Housing Code, Chapter 52
..Location Description A.r..t. Sec.
- ! , - . ~ ' ~
FORM f~O 6
TOWN OF SOUTHOLD
Building Deoartmem
Town Hal:
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
'nstructions
This application must be filled in zyoewriter 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
naturai or zopograohic features.
2. Finai aporovai of Health Dept. of water supply aha sewerage disDosal--{S-9 form or equal).
3. Aporoval of eiectrJcai installation from Board of Fire UnderwriTers,
4. Commercial buildings, Industrial buildings, Multiole Residences and similar buildings and installa-
zions, a certificate of Code comaliance from the Architect or Engineer resoonsibie for the building.
5. Submit Planning Board approval of comoleted site plan reouirements where applicable.
For existing buildings (0rior to Aoril 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing ali property lines, s~reets, 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 preoare a certificate.
Fees:
1. Certificate of occupancy S5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ...D~...c~-Lnb....er. ,!,..1.9.8.2 .........
New Building ............. Old'or Pre-existing Building . ~ ......... Vacant Land'. ............
Location of Property . .5]iP.~5, .~r.e.e~t,¢..Gr.e.~zpp~c.t~..Ncc..Y.o.r.k .................................
House No, Street Hamlet
Owner or Owners of Property . .S.a..dJ=e..W.i.l.s..cD..a=n..d..P.e?,cy..W.i.l~..c9. ..............................
County Tax Map No. 1000 Section .4.8...0.0. ......... Block .... .0.3:.0.0 ...... Lot, .0.2.8/.0.0.0 ........
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 $..5..0D ........................
Construction o~_~ve ~escribed building and p~mit meets all applica~Ce~odes and regulations. "~'/-, ?d~ Applicant...~.~...~.'.-,~, .....................
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