HomeMy WebLinkAboutZ-9629FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No...Z. ~.67.9 ......... Date ... Augl~.t. 'JO ................... 19.79
THIS CERTIFIES that the building ................................................
Location of Property 180-220 Lake View Terrace ........ E~ .~ar. ion
1213~ '1~oi ....................... 'S't~e3i ......... Ham/et
County Tax Map No. 1000 Section . .0.~.1 ....... Block .. -09 .......... Lot..017 ............
Subdivision...g~<:y~X'x:xx ................ Filed Map No .... ~ .Lot No.. ~..
· e imem n,~,s~.~ r . · · o
conforms substantiallyP~oC~erem n~[,~ r . ; .
· · ~RRIL..~.3 .......... 19.57Pursuant to which. O.e..e.uP..%r3.9¥. ~9629. · ·
dated .. AIJ~UST..1.0 ............... 19 7.9, 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 .. fop 'a ·
..... ozae..~ami-Z.~ .dweZ. ti~g..w/, gex, age. ~ceee.eo~y .............................
The certificate is issued to . M/M. ~[ALTE~{..R(~B.Z~¢~t~,./ds.~ie.dr.t33a.n.t) ......................
of the aforesaid btfilding.
Suffolk County Department of Health Approval ......... .M/R .............................
UNDERWRITERS CERTIFICATE NO ................. ~/R .............................
Building Inspector
Rev 4/79
Location
Subdivision
Name of Owner(s)
Occupancy
(type)
Admitted by: /~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(number & street) (Municipality)
Map No. - - Lot(s)
Accompanied by: ~.~
7 -77
Key available Suffolk Co. Tax No.
Source of request /~o/~/-F~/~/ ~O00COC-t~:2 Date g-?-77
Total rooms,
Bathroom~
Porch, type
Breezeway
Type Heat~
Fireplace(s)
DWF~LLING:
Type of construction ~O~--/"~/dF~- #stories
Fo~dation ~~ ~C/C Cellar~T~ Crawl space~_
1st. Fl(~_J~'2nd. F1 ~ 3rd. F1
Toilet room(s)
Deck, type ~ Patio,
Garage - Utility room
Warm Airo~~Ho~ater
Domestic hotwater
Other
NO.
Exits-~-~ Airconditioning.
Type heater~ ~-Y~z~
ACCESSORY STRUCTURES:
Garage, type const. ~v~ ~'~Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art.
See.
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
3. Copy of certificate of occupancy $1.00
$5.00
Date.· .'~, 7.?'.'; ?. ?. ............
New Building ............. Old or Pre-existing Building~)~ ........... Vacant Land .............
Location of ProperW ~.2~.. ~4~ W~ ~.. C..~..L ................ /.. ~-. ~ ~ ....
Hou~ No. St~t Ham/et
Owner or Owners of Prope~y ~ .~.~...~.qq~q~K ............................
County Tax Map No. 1000 Section ...~ ~./ ........ Block ..~ ........... Lot.~.7...~..~. ~.~
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 .......................
Fee Submitted $ ........ -" . (~ -' ~ '~
Construction on above described building and permit meet~ a~l applicable codes and regulations.
Applicant ~ ~,.?~/~ ........... ~,~. ~
....