HomeMy WebLinkAboutZ-9942FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No. Z9942
Date Flay 2 19 .~O
THIS CERTIFIES that the building ................................................
3500
~Z~ Grat;hwohl Road, Ne~ Suffo%k
Location of Property ...............................................................
Street Hamlet
House No. 1 10 14
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision ............................... Filed Map No ......... Lot No ....... ......
Re~uEre~,n~s flor a One-galley
. ~T$~..~ .......... , ]~7. pursuant to w~ch~P~t~E ......................
dated . ~. ~ .....................19.80,.. was issued, and conforms to a~ of the requ~ments
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
The certificate is issued to ....ff.Q .I~l...A.U.Z.X..N.S..&...I~..o. ...................................
{owner, lessee or tenant)
of the aforesaid building.
t~/R
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ..................................................
Rev 4/79
Location
TOWi: OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION R~POR~
3500 Grathwohl Road New Suffolk
(number & street) (Municipality)
Subdivision .Map No.
Name of Owner(s) John Auzins & Wf.
Lot(s)
Occupancy R-1
(type)
Admitted by: Mrs. Auzins
Okrner
(owner-~na~t)
Accompanied by: Mrs. Auzins
Key available__
Source of request Gary Flanner Olsen
Suffolk Co. Tax No. 110-8-4
Date 4/24/80
DWELLING:
Type of construction Wood Framed #stories
Foundation Cement Block Cellar Crawl space X
Total rooms, 1st. F1 3 2nd. FI 4 3rd. F1
Bathroom(s) 2 Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway. Caragq Attached Utility room
Type Heat Gas Warm Air Hotwater X
Fireptace(s)Air rite No. F~xits 3 Airconditioning
Domestic hotwater Yes Type heater Gas
Other
2
ACCESSORY STRUCTURES:
NONE
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description
Stairs Up No Hand Rail
Outside
Garage
Needs PaintiDg
Doors Need Repairing
Sec.
5P-77-~.
52-31 -B
Remarks:
Inspected by:~~
~/~f~-~._Date of Insp.
5/1/80
TJrne start11:00 end 11:25
FORM NO. ~
TOWN OF SOUTHOLD
Building Deportment
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
......... ...............
New Building ................ Addition ................ Old or Pre-exis~ng Building ...~, ...... Vaco2nt~La_n.d ..............
Property .... ~ %.,~ ~ ..~..~/~ ..~.....~.~.....~.~,...~...~.. ~j ........~.... ~.~i..~,..~~ rx ~.~,1~1 ............
Location
Of
Owner Or Owners Of Pr~;~';" ii~~..~~~....~..~...~..~....~.~..... II~, ........................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No ..................... Date Of Permit .................... Applicant ..................................................................
Hearth Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning g~Approvol ........................................
Request For Temporary Certificate ........................................ /final~C~rtificate ..... ~.,....~.. .......
Fee Cub it ~ ~ ~ ~ ~
Sworn to before me this
day of GARY FLANNI R OLSEN ESQ.
............................................................ .~ ~tct~np o~al)
[~. U. I~ox ~0
Notary Public .................................... County Main Road
Mattituck, L. I., N.Y. 11952