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HomeMy WebLinkAboutZ-10801FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..zl 0~J13.~ ......... Date ........ ~.et¢om. heC..4 ............. 1915.1. THIS CERTIFIES that the buildingS. ............................................... Location of Property ...1.2.0. ................. K. grg..~y.~rLu.~. ............. ~.o.u.g..h.o.l.d. .... Hou*e No. Street Ham/et County Tax Map No. ]000 Section .5.6 ......... Block . ...2 ........... Lot ....2 ............. Subdivision ....... XX ...................... Filed Map No... X ..... Lot No ..... X ........ Requirements for a private one-family dwellin~ built conforms substantially to the .Al~eliee~ie~-fer.-*l~geq~qs.~e~mit.~er-et.o~e~,e-ff*fled..i~4l~i~,,ef, fiee~ Cert:l.f:Lcat. e of' 0ccupanc7 prior..t~o. Alit2. ~.1..?,3... , 19.5 7pursuant to which ~Buikting. Permie-No ........... g. ! .0.~.0.1. .... dated .. P.e. cemb.e.r...6 .............. 19 .tt 1, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupaflcy for which this certificate is issued is ......... The certificate is issued to .............. .~9.n.a. 1..~. ~.,...&..~.q *..e p.h..~.:. ?.~.e..np.a.n. .......... (owner, d~t'aenantJ of the aforesaid building. Suffolk County Department of Health Approval ... ~.~/.~ ................................... UNDERWRITERS CERTIFICATE NO ........... .N/.R. ................................... Building Inspector Rev, 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location / o~ © /~q..~ ~ ~'~ (number & street) (M~icipality) Subdivision ~ Map No. N~e of ~er(s) ~ ~ .~ ~. /~~ Occu c (t~e) /' -- (o~er-ten~t) Aocomp d Key available ~ ~ Suffolk Co. T~ No. Source of request ~ DWELLING: Type of construction ~/0 d ~ Fom~dation /V/~£ o m ~?e 7 Cellar Total rooms, 1st. F1 5t-~2nd. F1 Date #stories ~'~ Crawl space 3rd. F1 Bathroom(s) I Toilet room(s) Porch, type ~, ~d~Deck, type Cd oo ~_~ Patio, t~pe_~__ Utility room /(~. j Breezeway Type Heat Fireplace(s) Domestic hotwater Other Garage -- Warm Air Hotwater ~ No. Exits _~ Airconditioning - ~-~ Type heater 7~ c~m~, ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 .Location Description Ar~. Sec. Remarks: Inspected by: Date of Insp. Time start 9,-~ end FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 lin~s, 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 requ ired 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 ............. Old or Pre-existing Building ....~. ...... Vacant Land ............. Location of Property .../.~..~.. ............ ........ //~.~.~..~.../~.~ .~. ........... House No. r Street Ham/et Owner or Owners of Property .... .~?..~( . o. ,5.r~/~, : i~..~' .~. ~..~f..~.' .~.. f. i . .............. CountyTax Map No. ~000Section ~c/ ~0 Block ~--);~q"~ Lot ~o~_ (.d..~. 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 ..................... Final Certificate .... ,~. ................ Fee Submitted $ ..~'..,...(~... ,/x" .... Construction on above described building and permit meets all applicable codes and regulations. SURVEY FOR KEITH JENSEN 8 TERRY AT SOUTHOLD ' TOWN OF $OUTHOLD SUFFOLK COUNTY~ N.~ 8CALE ~ I"~ 30' , ~V. 25,1981