HomeMy WebLinkAboutZ-9833FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.. Z~83~ .......... Date 0'a.I¥~ .a.rT..!./4 ................. 19.8.0
THIS CERTIFIES that the building ................................................
Location of Property .....
House No. Street Hamlet
County Tax Map Ho. ! 000 Section . .I06 ....... Block .... 02 ......... Lot ..... 0~ ........
Subdivision. ~apt,. I{:Ldli ~E~stla.te8 ........ Filed Map No..1.672...Lot No.. ~415 ........
conforms substantially to the ' ' ~ - '
Certificate of _Oocup_apcy
.... April. 23 ........ !9 -5.7. p~suant to which ~
dated ... January..1.l} ............. 19 0Q., was issued, and conforms to all of thc requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.................... PrJ. v. ate..One. F. amily..Iheellll~g ...........................
The certificate is issued to ...... William .l.. Bs~on ................................
(owner, le*see or t~nant)
of the aforesaid building.
Suffolk County Department of Health Approval ......... .IXI/R .............................
UNDERWRITERS CERTIFICATE NO ................. }I/R ............ ./. ...............
/- Building Inspectcr
Rev 4/7g
Location
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(number & street) (Municipality)
Map No. /~Z~ Lot(s) 1~,~
wrier-tenant)
Accompanied by:
Key available ~ Suffolk Co. Tax No,~~Z~
Source of request~_/~z~z~ ~. ~,~/~O~) Date
DWELLING:
Type of construction
Foundation ~%-~'~
Total rooms, let. Fl~2nd. F1
#stories
Crawl space
3rd. F1
Bathroom(s) ~--c/~- Toilet room(s) ~
Porch, type Deck, type -
Breezeway_~.__GarageC~~
Type Heat_~~'NarmAir ~
Fireplace(s) ~ No. Exits'F--~d
Domestic hotwater ~
Other
Patio, type
Utility room ----
Hotwater "'~
Airconditioning
Type heater ~A--~7-~TZ( ~
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Remarks: J ° . ......
Inspected by.~/~ate of Insp.
· ! /!
t ~ Time start/%7~., end Z/'-',,..~
FORM NO. 6
TOWN OF SOUTHOLD
Building Depa,{,;~ent
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate 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 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 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 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 or land use $5.00
3. Copy of certificate of occupancy $1.00
Date .Z', ',~, ,~,T. , ,~? ...............
New Building ............. Old or Pre-existing Building ,, ,~, ........ Vacant Land .............
Location of Property ~Nf~ ..... ~' '~'~'' '~' '~'
Owner or OWners of Property ..~/~..~..'..~. ~ .............................
County Tax Map No. 1000 Section ...t.O..~3..,..O.O.... Block ...O..'~....o..o. .... Lot.. O..~..~...o..o .....
Subdivision. C..~....~'.'.~..~..~ ......... Filed Map No..~..~.7..'~....Lot No.../'~...~...~. ....
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $. T-~.~. ,~.('].. ....................
Construction on above described buildinj~,d permit m, eet~licable codes and regulations.
Applicant~~.. ,~,~ ........... ..,.,.:, :~.~ .... ,, ~