HomeMy WebLinkAboutZ-10404FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin8 Impector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No ..... .~,$0t~ 04. ..... Date ....... ~®bru~Py. 2~ ........... 19.
THIS CE~T[F]FS t~t t~e buildin; ................................................
Cotmty Tax ~ap No. 1000 Section ... 2~ ...... Block ...... 2 ........ Lot ~..1.7. ............
Subdivision ............................... Filed Map No ......... Lot No ..............
Pequl~*ts,®nt;J fop & one-fa, mil}' dwelling built
conforms substantially to tlie-A~lsli~ies,~te~Bai~pm-mit-~~in-glis-ei~flce~ai~l---
dated ....... F.e b~'ua.~.~. 25 ........ 19.8 J, 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 .........
.......... Pr&va ~e..One.l~.amtl.y..Dwelltn& .... i ................................
The certificate is issued to ....... W&,I,1 tar~.. Il o. ~vod~e.t ¢ k...Jr...&. 1/! ...........
(owner, I~le' or tenant) .....
of the aforesaid building.
Suffolk County Department of Health Approval ...... N/R .................................
UNDERWRITERS CERTIFICATE NO ...... ~l,~ i~ .................................. ' ......
Rev. 1/81
Building Inspector
BUILDING DEPARTMENT
TOI'fN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ~~re M~i~cipal ity
Subdivision _Map No. ~ot(s)
A~itted by: ~ Accompanied by:_ ~ - ,.
Source of ~ - '
D~LING %
T~e of construction
Fo~dation ~. ~ ~ ~ellar~,~rawl space~
Total rooms, let. F1 ~ 2nd. F1 ~ ~rd. F1
Bathroom(s)~ Toilet room(s)_ / ...
Breezeway Garage Utility room
Domestic hotwater ,~< .T~e heater~
~CC~SORY STRUCT~ES:
Garage, type const.~St°rage' type conot.~
Swiping pool~ Guest, t~e const.
Other
VIOLATIONS:
Housing Code, Chapter 52
Description
Sec.
-/
Remarks:
T~me start~/, /5--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 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.
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 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
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property /7~ /~//e.~.,e /,.a, ~ ~ ~--~" ~ ~.
House No. Street Hamlet
Owner or Owners of Property . .~. ( !./.' .~. ~ .J.'~.. ~..¢.o..~.~. r. ~..~..~...w...~..'./.~..~. !.~. ,.~. ~ ..........
County Tax Map No. 1000 Section ...~'. ~. ........ Block ...... ~ ....... Lot .... / 7
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 $ ...... .~'..'~. .................. ~0~
Construction on above described building and,~t meets all apl~cable codes and re,~ations.
Applicant , .~ .~,, , ,~...~, ~. ,~. /~' *~
....... ·
R~.10-10-78 ~ · ~ ~ . ~