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Home My WebLink AboutZ-5841FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 581...... Date ................ ��?� i l...2 .. , 19.74. THIS CERTIFIES that the building located at ..Ackexly. Pond.. Lane. ..&..Lo�&reetoad Map No. `............ Block No.. " .... Lot No.. ? ...uouthold N.Y. reouireren.tsgr one family �ltrelling& lousing code conforms substantially to thei;;iee opre;ileti�irhr builtcertificate of oocuDancy dated befcre.. ll?? '? . 23 ..... 19 . �7. pursuant to which B gLjAiLpyoB�ANo. z 5811:1... dated ......... Ap rill... 2.... , 1974.., 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 .N.C. Private one family dwelling The certificate is issued to .'toFan.. Zebrosl� t...... mo ....... .......... ... . . (owner, lessee or tenant) of the aforesaid building. Suffolk County- Department of Health Approval pre -.existing ..................... UNDERWRITERS CERTIFICATE No. .premexis:ting ............................. HOUSE NUMBER 375.......... Street . Acl�erly Pond. Zane ................................................................I.............. �` '..... ` ......... ...... Building Inspector HOUSING CODE INSPECTION April 2, 1974 Ackerly Pond Lane & Lower Rd. Southold, N.Y. Tax Roll: Stefan Zebroski 375 Ackerly Pond Lane Southold, N. Y. Upon request of the Southold Town Building Department I made inspection of this one family dwelling and found the following violations of Local Law #1, Housing Code, Town of Southold. No Heat - Article V, Section 52-53 A-1 Kitchen Gas Range - No shutoff on cooking side - Art. V. Section 52-52 B-2. Bathroom - No Sink - Article V, Section 52-51 D-2. Exterior - south side roof - shingles deteriorating and breaking off. Article III, Section 52-31 C. � 1 Zectfully submitted, Hi >1 � - -- Edward Hinder ann EH:mm Building Inspector FORM NO. 6 j TOWN OF SOUTHOLD i 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 DUPLICATE to the Building Inspector 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 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 of 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. Copy of certificate of occupancy $1.00 Date .... ...�.�......7�............... New Building ................ Addition ................ Old or PP e -existing Building . /..... Vacant Land .............. Location Of Propertylr? r�..... 7'/�"P�rr �,.,�.�2;..°`-i'�,% Owner Or Owners Of Property y l4r� �r .rs .......r�gZ0 & ............................................................ Subdivision Permit No ..................... Date Of Permit . Health Dept. Approval ......................... Underwriters Approval ........................... Request For Temporary Certificate ......... Fee Submitted $ ...................... .....Lot No ............. Block No............. House No............. .....Applicant.................................................................. .....Labor Dept. Approval ................................................ .....Planning Board Approval ........................................ Final Certificate .......................................... Construction on above described building on ermit meets ap licable codes and regulations. Applicant ...........�I..f�?�c................... X45`�!E!Y..G.I.............................. Sworn to before me this - r ....rle .. day of .... �......�..%.!7" ( mp A�arseal) Notary Public .................................... County ____ ___ ____ i -- � r __/ �� L/(/ i r � . � - c� ---- �. -� `��`j `�- - � /L� - - - - - - - -- - - - r l t 'f .� --- - - � _ _,-.