HomeMy WebLinkAboutZ-7633FOB,M NO. &
TOWN OF SOUTHOLD
BUH,DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at ... g~..n.e..ha.h.~. B.l.v.d. ......... Street
Map No.. ~ ........ Block No... ~ ..... Lot No....x~....~..c~. ~c.h.o.~.d...~ ;.Y.. ..........
conforms substantially to the re ~nt~ ~n £ d w~l & lng code
Built before , ,e~~~occu~ancy
dated ............. .APr...2~, 19.~?.. pursuant to wnicn~o. Z7~.~3 · ·
dated .......... .l~y...2 ...... , 19 ?.~.., 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 . PY. iYaJ4e. 9n~..~am~!~.'..d.~.~:~.l.ing. ......................................
The certificate is issued to . Ii~y. ~,. ~-.d.r$¢b, ~. wl.f.e ..... .o~c~ ................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Pr.er: .ex~-.~.g!.ng ....................
UNDERWRITERS CERTIFICATE No. p.r.e.-..~.x.l.s.t.~..ng ............................
HOUSE NUMBER ....... ~.1~8.~... Street . .l~.i.n..e.h.~.h.a.. B.l.¥d. ...... .S.o.u.~..hp.l.d' .........
HOUSING CODE INSPECTION
April 29, 1977
3485 Minnehaha Boulevard
$outhold, N.Y.
Tax Roil: Henry M. Aldrich & wife
Unoccupied
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy, I made an inspection of this one-story, wood framed
dwelling. I was admitted to building by Mr. Aldrich who accompanied
me during this inspection beginning at approximately 9:00 A.M.
The building consists of a living room, kitchen with eating
area, full bathroom, and two bedrooms. These rooms of dwelling
were constructed on a cement block foundation with crawl space.
Balance of dwelling constructed on concrete slab consists of a
sun porch on east side, a den, laundry room and utility room. Heat
is furnished to all rooms from an oil-fired, hot water furnace lo-
cated in utility room.
I found no violations of the Housing Code, C~apter 52,
Town of Southold, New York.
/
Inspection was completed at a~oxima~/9:20 A.M.
~ //
Re ~p~c~ f ul ~y ~ubmitted,
Building 'Inspector
EH:med
FORM NO. 6
TOWN OF SOUTHOLD
, 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 ......~...~....T~......~..~,~ .../..?..~.. ~. .......
New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ..~?....~...,~.........I?.!.?....~...~..H....~.....N....~. ........ ..~...L.:..~.i'....~......~.......,~....O...~..T...H....0...~.;..b.. ................
Owner Or Owners Of Property ..... ?I..?...N..~.~......~........~......~.~,...~.?...A...H.. ....... ..~1.. ....... ~..~...~....~..!..~....~.. ................
Subdivision ......................... ~ .................................. Lot No....~ ........ Block No......~T.. ..... House No..-~....~...-~....
Permit No. -- Date Of Permit .........~. ......... Applicant ..................................................................
Health Dept. Approval ........................... : ................ Labor Dept. Approval /~- ~,
Underwriters Approval ................... .N...~...T~.....: ............. Planning Board Approval ........... .~..~...'....~.....~ ..............
Request For Temporary Certificate ........................................ Fined Certificate ..........................................
Fee Submitted $ ........... .?~...~ ............. /
on above described buildin~ ,r'n~it.m~jj~^a.I ~pI~' ~blekc~des~ ~/ lu-,- I/I/, , lIV//,~,/~.- and regulations.
Construction
App lie, rl~...../k~..v~.....~ ....'.. '. J.., ....~.~.....~......~_~/~/~ .............
...... ~day o~ J (stamper seol).)~~ ~k/'/',j~,2~
Notary Public ... ~