HomeMy WebLinkAboutZ-9468TOWN OF $OUTHOLD
BU~.niNG DEPARTMRNT
Town Clerk% O~iee
$outhold, N. Y.
Certificate Of Occupsncy
THIS CERTII~IES that the buildin~ located at . ~.9.~..~ .... .M.a.t.n...R.d., ........
Map No... ~. Block No..~.Lot No .... ~ ..................
REQU~S FOR ONE FAMILY DWRI.LII~ BUILT PRIOR
conforms substantially to the
TO April 23 , 19.~.7.. pursuant to which ~ No. Z94~ ·
~...................... CI~TIFICATE OF 0CCI~CY
dated .....~.a.F.c.h...~.9 ........ , 19..7~ 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 ....... .Pr..i.v.a.~..e...O~.e...F..aLn..i.l.y' . .Dw. e. 1..1.i.n.g.. W.l.t.h...A.c.c..e?.s.o..~. Struo'*,mre
The certificate is issued to Lilli~mn .Bauer & ors.
of the aforesaid buildi.g.
Sut~olk County Department of Health Approval ......... Pra.,Ext~cinF~ ............
UNDERWRITERS CERTIFICATE No .................. P~.e.-Existtng ............
HOUSE NUMBER ......... Street Pe Y.
......... [~ ......... ~? ....................
Building
County Tax Map Number
1000-085-02-008
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location J~- /~4,~/~o
(number & street)
Subdivision - Map No.
(Municipality~
Lot(s)
Name of Owner(s)
Occupancy /~/
(type)
Admitted by:
(owner-tenant)
Accompanied by:
Key available -- Suffolk Co. Tax No.
Source of request/l~r- ~T~. ~-~O~/F- Date
'/!
DWELLING: ~7-~
Type of construction ~0~ ~--/~,~ #stories ~ !
Foundation ~/~/f~ZL: ~/~ Cellar ~-~m Crawl space ~/~T'/-
Total rooms, 1st. FI
Bathro om ( s )
Porch, type ~z&- ~<~ Deck,
BreezewaM Garage
Type Heat 6w~zg~Z_ Warm Air
Fireplace(s)~No. Exits
Domestic hotwafer ~/~.
Other
2nd. FI~) ?'.~3rd. FI
Toilet room(s) '-'
type ~' Patio, type
Utility room
Aircondi~ioning.
Type heater ~MK ~z~g2
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
, .Location Description Art. Sec.
Remarks:
Inspected by!, Date of Insp. ~-/ff--
Time start~.~o ~.~ end
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 folbwing; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, an6
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 complel'ed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
I. 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-existing Building .... ..x. ......... Vacant Land ..............
Location Of Property Main Road. Peconic. New York
Owner Or Owners Of Property William A. Bauer /,I ]..L/ fi/~
..................................................................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House 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 $ ........... ..~.... .................... ~ ~ ~5"~ - ~
Construction on above described building and permit meets all applicable codes and regulations.
pp ' t ..~.~.~ ...... :......~~ ..........
(Robert L. Tooker, Attorney for o~er)
Sworn to before me this
14th day of March, 1979
NOTARY
~/,~ (~4_~__~,~._~o fl0. 52
(stamp or seal) ~.
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