HomeMy WebLinkAboutZ-10337FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
To'wn Clerk's Office
Southold, N.Y..
Certificate Of Occupancy
.... · ~ -z~ ..... Janua.I~ .7, ................ ,19 81
No. ?...,0 ~,..:7. Date ................
THIS CERTIFIES that the building ................................................
Location of Property ..... .I 7.0.0..~r.~.t.h..w.o..h~...R.op.d., ............ .N.e.w..S..u~.f. ql..k,..h.': .Y:..
House No. Street Ham/et
County Tax Map No. 1000 Section .... 1].? ..... Block ...... /4 ........ Lot ....... 3 .........
Subdivision ............................... Filed Map No ......... Lot No ..............
· r.¢~,uir~me~nt,s for a One Family Dwe,l, ltn[ Built_Prior to
conforms substantially to the ~pl~d~,.~m--~er-~hl4~g-~r~.i.t-~e~et.e~e~e-f'~~ -
. Certif£cate~ of..Occ_upancy
· J. pril . ? ~, ......... , 19 . ~ .Tpursuant to wmcn ~m~n~.r. ol;mt;-i'~o, ....... Z&033.7. ......
dated ...Janizary..7., .............. 19.8.1, was issued, and conforms to all of the requirements
of the apphcablc provisions of the law. The occupancy for which this certificate is issued is .........
.............. P. r~:c:t.e..0.n. ~. ?;..m.~.~.y. ~.?...1.1.~.n.g ..................................
The certificate is issued to . . .'W.~l. 1..:L~.~...B.l.a.~.q .h.a.r.d...a.n.d....~.l.f.e. ........................
{owner, ~x
of the aforesaid building.
Suffolk County Department of Health Approval .. · I~I ~FL ...................................
UNDERWRITERS CERTIFICATE NO ..... I~I/I:1 .........................................
Building Inspector
Rev 4/79
BUILDING DEPARTMENT
TO¥~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
Subdivision
1700 Grathwohl Road~
(number & street)
Map No.
New Suffolk
(Municipality)
.Lot(s).
Name of 0vmer(s) William Blanchard and Wife
Occupancy R-1
(type)
Admitted by: Self
Unoccupied
(owner-tena~t)
Accompanied by: Self
Key available A.Blanchard
Suffolk Co. Tax No. ,1,17-4-3
Source of request Gary Flanner Olsen
Date 1/5/81
DWELLING:
Type of construction Wood
Foundation Cement Block
Total rooms, 1st. F1 4
Bathroom(s) 1
Porch, typ~ Glassed in
Breezeway
Type Heat Oil Fired
Fireplace(s).
Domestic hotwater Yes
Deck,
Garage
#stories One
Cellar Partial Crawl space Rest
2nd. F1 3rd. F1
Toilet
typ~
room(s)
Patio, type.__
.Utility room
Hotwater X
Airconditioning.
Gas
Warm Air
No. Exits 2
Type heater
Other
ACCESSORY STRUCTURES: NONE
Carage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Lo.cation Description Art. Sec.
Kitchen Gas Stove no shut off V a?-a?-
Remarks:
1/7/81
Inspected by:(~.c.~'~/~//?-~.~?~Date of Insp.
Curtis Norton Time start 11:00 end
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 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-conf.orming 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
Date ...... ~ .~.k .J'~ ~) .........
New Building ............. Old or Pre-existing Building .... ~ ...... Vacant Land .............
Location of Property .... G..~...~,~. ? .~. L..~....~.,....~...8~...~..~,. ..................
County Tax Map No. 1000 Section .. ! .~..~. ........ Block ..... .~ ........ Lot...~.'.~ ...........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ................ ~al Certificate ....~ ................
Fee Submitted , . . .5~'.. c=4~.,,~.. ............... /
Construction on above described building and per~,~y~co~and regu latio~