HomeMy WebLinkAboutZ-11413FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.I.?. ).3 .......... Date ....... g..a.n.u.a.v..y..5 ................ 19.8.3.
THIS CERTIFIES that the building ................................................
Location of Property ' 1500' Grand Avenue Mattituck
h3&s'o 'do: ....................... 's't/e3i .......................
County Tax Map No. 1000 Section . . 1. 0. 7 ....... Block .... 0..3 ......... Lot . 0 1 2
Subdivision .... .X .......................... Filed Map No. X .Lot No. X
Requirements for a private one-family dwelling built prior to
conforms substantially to the Ap.p14~a. tima-~q>.~ 4?mitd~g~-heretofore- ill'ed-in -thi~-cffficerd'atc-d-
Certificate of Occupancy
·. p,.p.r. J~ ~_..2.3 ......... , 19.5.7. pursuant to which Bxritding-Pernlit- No .... .Z.1.1.~ ! .3 ...........
dated ....J.qr~u..a.r.y..5. .............. 19 ~3.2., 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 private one-family dwelling.
The certificate is issued to ..... .A.r0q ~. j_.a..A..n?.i.g '[o~n'o'r,f4~t,o'a,'~r.[t~-t~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval .... .n/.a. ..................................
UNDERWRITERS CERTIFICATE NO ............ r~/.~. ..................................
*Official house number issued by the Town of Southold
Building Inspector
Rev. 1/81
Location
Subdivision
BUILDING DEPARTMENT
TOV~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(number & street)
Name of Owner(s)
Oocupano
(t~pe)
Admitted by:
Key available
Map No.
(owner-tenant)
Accompanied by:
Suffolk Co, Tax No.
(Municipality)
-- Lot(s) --
?~LLING:
Type of construction
Foundation
Total rooms,
Bathroom(s)
Porch, type
Breezeway
Type Heat
Fireplace(s)
~/~ ~ ~ ~ /~j #stories
~~ Cellar ~r- Crawl space.
1st. F1 ~ 2nd. F1 ~ 3rd. F1 ~ / Toilet room(s) ( ~
~ Deck, t~e ~ Patio,
~ Garage ~ ~ Utility room
/
type
Warm Air ~Y~ Hotwater
No. Exits ~ Airconditioning
Domestic hotwater ~
Other /~'~ ~/~ ~
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Type heat'er
Storage, type const. ~
Guest, type const. ~
yIOLATIONS: Housing Code, Chapter 52
_Location Descriotion Art. Sec.
Remarks:
Inspected by: % ~7 Date of Insp.
· Time start /~ 50
end I~ i ~
FORM NO. 6
TOWN OF SOUTHOLD :
Building Depar~men~
Town Hall
Southold, N.Y. 11~71
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and subr~itted in duplicate tothe 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 tooograohic features.
2. Final approval of Health Dept. of water supply and sewerage disposa --(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildfng~ 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,
For existing buildings (prior to April 1957), Non-conforming uses, or buildines and "pre-existing"
land uses: -
1. Accurate supyey of peoperty showing all pronerty 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 informa-
tion required to prepar~ a certificate. / ' ·
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.O0
S5.00
Date.. Iz/zct/~Z
New Building .............Old or Pre-existing Building(X) =/Vacant Land
' ' ............
Hour No. ' ' " .... ~ ....... "~ "'
· '~ ..~t.~' Street It;re~et
Owner or Owners of Property ... . 't~ . .
County Tex Map No 1000Section .... /.~..? .... ' Block .... ~).'~....i... Lot...~..('..~. .......
Suboivision ~
............................. Filed Map'No. ,.: ....... Lot No ..............
Permit NO ..... .~. Date of, _r ..... ^-,~ ' --- /~
-
Health Dept. Approval .... ' ........ Labor Dept· Approval . . .~
Under~,vriters Approval ~ ,~
....................... Planning Board Approval .................. ~ ..,
Request for Temporary Certificate. .Final Certificat~ ....~.-.
· ......... . ......... .
Fee Submitted S... ~ .......
Construction on above described building and perr~it'meets all appfi, cable_..codes and regulations.
¢¢. ·
Apolicant .; ........ :'- ........ "/-.. . ............... . .....
CErTIfIED TO:
/~AdL~P O~ L~UIL DII~IG ~ ITE~
0~- A4~. JOl-il~l /~IUTTI TT
M,'~ T T I TUC I~