HomeMy WebLinkAboutZ-12679FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.1.2.6.7.9...P.r. 9' .C.C. Date Aug. 8
................................. 19.84..
THIS CERTIFIES that the building .s (3.) ~. ~'=' ......
805 Little Peconic ~ay ~u. '
Location of Property 3.695 Hayw. aters Rd. Nassau Pt. Cutchogue
House No. Street Hamlet
County Tax Map No. 1000 Section ...]: .1.1 .... Block 11 023
Nassau Pt. Club Propert~ ................ Lot .................
Subdivision Inc. Amended Map,sect.D FiledMapNo .8.q~ .LotNo. 401
-Requirements for a priva.t=e one family dwelling
conforms substantially to the
built prior to
......... Ap.r.i..1 ..... .2,319 .5.7. pursuant to whic~Cl~ir~f~l~,f ..... Occupancy........g126.7.5.
dated ........ A. Ug.... 8 ............. 19 .8.4., 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 .........
A p. rivate one family dwelling,detached 2-car wooden garage,& a
wood fram storage building.
The certificate is issued to ALEXANDER ADAMS & WIFE
....... [owner~e~ee,~'~' .....................
of the aforesaid building.
Suffolk County Department of Health Approval No record
UNDERWRITERS CERTIFICATE NO. No record
Building Inspector
Rev. 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
· ~outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitte .d-~'~_-'F.~:c:c 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 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 bu ildings.
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/ land use --?re-Ex±st±ng C. 0. $15.00
3. Copy of certificate of occupancy $1.00
Vacant land C.O.. $ 5.00
' / '';~;~ iLi~ ............ ..~ Date .
New Building ............. Old or Pre-existing Building ............ n .............
Location of Property..Hou~aNo..~..0.. ?~. . .~. :.~. . ./.~. .~.~.c!.~,:c. . .~. ~ ....... ~. . . ~/~G,. ~.¢~,f.~, . ~, . .~ ~. ,Ham/et '~
Owner or Owners of Proper ...... ¢~ t~....~4~...t~0~'.~...~., i£~. ................
County Tax Map No. 1000 Section .... i.(.l ....... B~ock .... [.[ ......... Lot .... .0. ¥.¥. .....
Subd,vision
· .Filed'MaP No. .G.Cot No ~ / ......
~,~ '~-¢, ~. ~ ' .....
Permit No....'~. ...... Date of Permit .......-~'7...Applicant ...................
·
· .. · .""v~O....~-~..-~ .... Labor D~pt. Approval . ..
Health
Dept.
Approval
BLDG. DEPT.
Fee Submitted $ .... ~ [ ..~ .' J' .... ~. · .:' ............ TOWN OF SOUTHOLD
Construction on above described building and,d~rn~it meets all ~licaDle codes and reguiations.
'"~'-I~,.~ , )~. /L~ .- ~'~ Applicant'. ~i .....................
CONSENT
TO
INSPECTION
do(es) hereby state:
· the undersigned,
That the undersigned (i~) (are) the owner(s) of the premises in the Tov~n
· which is shown and designated on the Suffolk
County tax map as District 1000, Section I! ( , Block ! ! , Lot e9 ~l ~ .
That the undersigned (has) (have) filed, or caused to be filed, an apptica-
tion in the Southold Town Building Inspector's Office for the following:
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, including
any and all buildings located thereon· to conduct such inspections as they may
deem necessary with respect to the aforesaid application, including inspections
to determine that said premises comply with all of the laws, ordinances, rules
and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the
knowledge and understanding that any information obtained in the conduct of
such inspections may be used as evidence in subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations of the Town of Southold.
(dignatur 9~-
(print name)
(signature)
(print name)
BUILDING DEPARTMENT
TOWN OF SOUTNOLD, N. Y.
HOUSING CO__DE INSPECTION REPORT
Location ~0~- ~',/7~- ~-
(n~ber ~ ~tr~t)~ ~ (M~icipali~) /
Subdivision~ ~ ~ ~ap No. Lot(s) ~/
N~e of O~er(s) ~/~
(type)
A~itte~ by: ~~ Accomp~ied by:
Key available o,,~_---M~ Suffolk Co.
Source of request ~/~./;~i,~' /~/&Cr.
Tax No.
Date
DWELLING:
Type of construction ~oz~ ~~
Foundation ~~- ~ Cellar~y//
Total rooms, let. F1 ~ 2nd. F1 ~
Bathroom(s) /~< C~, Toilet room(s) ~
Porch, type.~/~ Deck, type Patio, type
Breezeway -- Garage -- ' Utility room ~
Type Hca ~~_~Warm Air~_~_~Hotwater ~
Fireplace ( s ) No. Exits Airconditioning
Domestic hotwater ~;?~ Type heater ~ ~
Other
#stories
Crawl space
3rd. F1
ACCESSOR_YSTRUCTURES: ~ ~
Garage, type const.~~-Storage, type const.~ /-'~-,~
Swimming pool Guest, type consto
Other
VIOLATIONS: Housing Code,~
Location Description Art. Sec.
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
· %uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitte~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 feat~ 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 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
/
~. Copy of certificate of occupancy $1.00
landuse--Pre-Existing C.O. $15.00
Vacant~la~d C.O. $ 5.00
Date .... ~...~ .~. [~.~. ..............
New Building ............. Old or Pre-existing Building ............ Vacant Land ...........
Location of Property . .~.....~.~ .
Hamlet
Hoe, No. ~ Street~.C?.~.~-- .I~.
Owner or Owners of Property ~i~>,a~Jev- ~ ~/~&//~.~.~v ~..
Count Tax Ma No, 1000 Section
Subdivision. '~C...~'...~....' .~... :~ .Filed' ~lap No..~...~.....Lot No ...... .z~ ....
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ..... ~ I.~. .............. Labor De, pt. Approval ........................
Underwriters Approval ................... Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Sub ~ ~
mitted $...: .........................
Construction on above described building and~/,~t meets ~J ap/~a/~ codes and regilations.
r~"'~ X ~~ ~-~'~ Apphcant .' .(.~o.~ ........ ~_~ .(~.:~.x~.~..
' .................