HomeMy WebLinkAboutZ-10253FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Date November 15, .....
.................. ~ ............ 19 80
THIS CERTIFIES that the building ................................................
Location of Property .... ~.8../4.0..N..~ .s.a.u.. ~.o.i.n.~...R.o.~d. ! ........... .C.u?.c.h..o..~.e. !..N...Y. :...
House No.
'11'1 S"~)"~ 2'--' 0020.2
Hamlet
County Tax Map No. ] 000 Section ............ Block ............... Lot .................
Subdivision .N..a.s.s.a.u...P.o).n..t..C.]:u..~. ?y.o..p:...Filed Map No ......... Lot No. 'it,0
requirements for a One-Family Dwelling Built Prior to
conforms substantially to the ~l~E, cati6rr-f~rBt~fl~ing"l%'mrit'~m'et-ofor~-ffied"l'rrT~~-
April 2~, ,19 ..5.Tpursuant Certificate of Occupancy Z10253
........... : ......... to which B~fi~l'i~g'l~rmdl~o'.- .....................
dated ..... ~..o?.m.~..er..1. ~.! ......... 19.8..0, 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 .........
Private One-Family Dwelling
Richsrd gnderson
The certificate is issued to ..................... [o~;n'e'r,~~Sr~ ..................
of the aforesaid building.
Suffolk County Department of Health Approval
UNDERWRITERS CERTIFICATE NO. N/R
Building Inspector
Rev 4/'/9
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
(n~ber
Subdivision
N~e of 0~er(s)
Occupancy /~-- /
(type)
Admitted by: ~=-~
Key available
(owner-tenant)
Accompanied by:
/do~/'/
Suffolk Co. Tax No.
Source of request~
Date
DWELLING:
Type of construction .(ZYoo~ ~f2~f~
Foundation
~'-~
Total rooms, 1st. FI %g C~J~ 2nd. FI
Bathroom(s) o~
Porch, type Deck,
Breezeway Garage
#stories ox~
Crawl space~9~FL
3rd. Fi ~
Toilet room(s).
type do~o~ ~'.~DPatio, type --
Utility room ~
Type Heat ~lg-~ 6_ Warm Air ~--~c~/~Hotwater --
Fireplace(s) ~3~ ~ No. Exits ~ Airconditioning.
Domestic hotwater ~ T~e heater ~c~/~/~
Other
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
S~orage, type const.
Guest, type const.
yIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Inspected by: . ~ate of Insp.
Time start/:~ ~/~nd ~!~ ~/-~
1~01~ NO. $
TOWN OF $0UTHOLD
, Building Deportment
Town Clerks Office
$outhold, N. Y. 1197]
BLOCK
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 oil 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.
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.
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
....................
law BHilding ................ Addition ................ Old or Pre-existing Building ...~.. ....... Vacant Land ..............
~cotion Of Property .... .~....~..~.?~..~..;..¥.../t~.._.~...~..;Z.~..,,C~..~lil~.{~,~.,.....~..~.~'1 ~' --il'" ~1~'~ -- ~'~ -
~vner Or Owners Of Property ..~....~t..~..~...~...~"~.. .~~ .........................................
Jbdivision I~..~-....~.J~.~.......~r.~..~,..~.....Lot No. ~.~..~..... Block. No ............. House No .............
strait No ..................... Date Of Permit .................... Applicant ..................................................................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .... .......................................... PI~ Board ApprOval ........................................
Request For Temporary C~rtificate' .......................... /./ ~l/inel Certificate ..... ~. ................................
Fee Submitted $ .....~.'-~...0...! .................... /,,~, Y
Applicant . ..~....~. ~'~~ ....~... ........ ~.' ........................
Sworn to before me this
GARY FLANNER OLSEN ESQ.
day of
P. O. '
Notary Public County Main Road
Mattituck, L. I., N.Y. 11952