HomeMy WebLinkAboutZ-10867FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that thq. building ................................................
Location of Property ...2225 .......... lq~>.r.t b. ,$.~1. I~le.:l.v.q ........... $9.u.L.b.o..1.d ........
House No. Street Ham/et
County Tax Map No. 1000 Section . DS.q ....... Block . 0.4 ............ ]Lot . .0~..3. ............
Subdivision... J{. ................... , ....... Filed Map No. ~( .... '..Lot No .... .X .........
Requirelents for a private one-family dwell.inK built prior
conforms substantially to the Al~plicatien-l:or-gmlding-l~rmi<-horet~,r~e.(k~d-i~-t~ia-e~e~lat~d
Certificate of Occupancy
dated ...... .d'?lr~ ~ t~'.y.. 29 ..........191~2., 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 .........
The certificate is issued to ..... sl 9.,hj1. l~.e?.g,~ '~rom
of the aforesaid building.
Suffolk County Department of Health Approval ...... ~/)1. ................................
UNDERWRITERS CERTIFICATE NO .............. N/:~ ·
Building Inspector
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
Subdivision
2225 North Sea Drive
(number & street)
x ,,Map No.
x
Southold
(Municipality)
Lot(s) X
Name of Owner(s)
Mr. John Bergstrom
Occupancy R-1
(type)
Admitted by: self
unoccupied
(owner-tenant)
Accompanied by: self
Key available First Towne Realty .Suffolk Co. Tax No. 054-04-23
Source of request Rudolph H. Bruer
Date 1/11/82
DWELLING:
Type of construction
Foundation cement block
Total rooms, 1st. F1 4
Bathroom(s)
Porch, type
Breezeway
wood framed
Deck,
Garage
#stories 1
Cellar Crawl space x
2nd. F1 3rd. Fi
Toilet room(s) 1
type. Patio, type
.Utility room
Type Heat
Fireplace(s)
Domestic hotwater
Other outside shower,
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
yes
electric
Warm Air Hotwater
No. Exits 1 Airconditioning
Type heater electric
heater kitchen area
NONE
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
~oilet roon no bathtub or shower V 52-51-D
not enough heat p. rovided V i2-53-A
Remarks:
Curtis W. Horton
Date of Insp. January 29, 1982
Time start10:1) end 10:30
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
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 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 featu res.
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. '
B. 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 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 prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
New Building ............. Old or Pre-existing Building .. ;~ ........ Vacant Land .............
Location of Property ..... ~oz'~h. Sez~ .Dri.~.e,. SQutho&d,. N~w. YD~:k ...................
House No. Street Hamlet
Owner or Owners of Property ,. ~o.t~1~1. ~e.~cj'.s.~,z~c)~ .........................................
County Tax Map No. 1000 Section .... .5.~ ........ Block .... ~ .......... Lot..2..3 ............
Subdivision ........... , ......... ............ Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant . .~.a.~.e.~..c.e. ~ ~..~.e.a.=..1.s.t.e.i..~ ......
Health Dept. Approval ........................ Labor Dept. Approval ....... ' .................
Underwriters Approvat ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ....x. ..................
Fee Submitted $ .... 5.QQ.../ ................
and
regu
lations.
~'SJ~ ~ Applicant. ~'~..~..L~/-~/7' ,7~-~'~~
olph H Brue~;' XEE6 H ' 'fda'
{~ Bruer, Attorney' 'f6~
~olpk Pearlstein