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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~.~.. ' .................