HomeMy WebLinkAboutZ-9636FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building ................................................
Location of Property 1725 Smith Drive, North .....
County Tax Map No. ]000 Section ....0.7.6. ..... Block .... .0.3. ........ L~t ....0.0.1. ..........
Subdivision ............................... Filed Map No ......... Lot No.
Requirements for a one family dwelling built prior to
conforms substantially to the ~ ~r~-~-; _--~----~ ~_-~_----.~-~;-~ ~- ~ ------:'---:'.k
Certifioate of
..... .Ap.rJ, l...2~., ...... 1957. pursuant to which:~l~~ . .Z.9.~.~.6...
dated .. ?.u.g!l..~.~.. q..~ · .............. 19 .T..9., was issued, end confo~am to all of the requirements
of the applicable provisions of the law. The occupency for which this certificate is issued is ......... One family dwelling with accessory struc, ture
The certificate is issued to . .~0.b.~lrt. D....~. LUellR .G, · ~RIC~. · · · ......................
of ~e sfo~ b~ld~g.
Suffo~ Co~ty Dep~t of He~th App~v~ ............. ~/~ .........................
~ERWR~ERS CERTIFICATE NO ..................................................
Bufld~g Impector
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-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 safeW 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 $1.00
,5.00
Date ...... .'~..[ .............
New Building ............. Cid or Pre-existing Buildiag..(~. ...... Vacant Land .............
Location of Property..~'..~...~. · .~. ·...~. · · .V~.'~...~.. · .~'. · .'~...~ ..............
Hou~ No. ~ ~ ~ Strut ~ ~ ~ ~ ~ Hamlet
Owner or Owners of ProperW .~~ t .~.. ~...~. · ~. ~~ ........
C~nW Tax Map No. 1000 Section ..~.. Block ...~.~ ....... Lot .... ~) .......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for .............. ~-'~ =~;~cate ..--~
Temporary .~i~icate ..... y,..., iai C~.,7 .................
Fee Submitted$ ~ d~~ '~/ ~
Construction on above described building an regulations.
Applicant .........................................
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location /
' ('rfumber & street) -
Subdivision GdT~7~ ~/~c/-_ Map No.
(Municipality) /
/gz~ Lot(s) ~
Name of Owner(s)
Occupancy
(type)
Admitted by: ~-
/
( owner-tcn~nt )
Accompanied by:
Key available Suffolk Co. Tax No.~~_~-(2)O)
Source of request ~ ~/~Q ~(~. ~' Date ~,~/~
DWELLING:
Type of construction ~/~m~ #stories /y~
Foundation d~t~/~7-- ~/oo& Cellar~/~ Crawl space ~
Total rooms, let. F~,-s~ 2nd. FI~Z¢~ 3rd. F1
Bathroom~ O~ Toilet room(s)
Porch, t~e - Deck, t~e ~- Patio, t~e ~
Breezeway Garagq Utility room --
~e Heat~~Warm Air Hotwater~ ~
Fireplace(s) ~ No. ~its ~O Airconditioning ~
Domestic hotwater ~ T~e heater ~Z~C~/&
Other
ACCESSORY STRUCTURES: ~
Garage, type const. ~~rStorage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.