HomeMy WebLinkAboutZ-10145FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Date ....... S..ep~.e.m.'p..o.r..! ? ............ 19 ~.0.
THIS CERTIFIES that the building ................................................
250 Private Rd. #17
Location of Property .... 25.0.0. P.ara. d~$.e..PO;[~qt. RO.a.d
............ ~9~. ........
House No. Street Hamlet
County Tax Map No. 1000 Section ..... 0~.1 .... Block ....... 3. ......Lot ...0.! ~ ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
,ReguAremen~s .,for,. a one~f~m~lyd~elltng.bu~lt ,Prior to
conforms substantially to
~ f at. f Occupancy
· .. April. 2.~ ........ ,19 .5.7. pursuant to
dated .... S.e~t¢;ab. er..~.~., ......... 19. ~l.O, was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
..... Oo~e~ily.dw~ll~g.w$¢h.ooo~ory..bugldl~g .........................
The certificate is issued to .... LOORa. x?. qt..E.....~T~, qe. ....................................
of the aforesaid building.
Suffolk County Department of Health Approval ...... .I}I/.R. ................................
UNDERWRITERS CERTIFICATE NO .............. ~I/.R. ................................
///
· .,:...~.~ ~...~..~/z....~. :...,~...~..
Budding Inspector
Rev 4/79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING C0DE INSPECTION REPORT
Location Z..,'~ ~ ~,,'q/Z,~ Z)/~ ~,~7- /~
(number & street)
Subdivision ~ Map No.
N~e of ~er(s)
Occup~cy
(t~e)
A~itted ~:
(Municipality) Lot(s)
{owner-tenant)
Accompanied by:
Key available/~--7~///'~<~folk Co. Tax No.~_~_2~_-O/~
Source of request
DWELLING:
Type of construction ~/~c.O ~r/~/~/~ #stories
Foundation ¢'-;r/~r~- ~c ~ Cellar ~r~ Crawl spac e~Z~_
Bathroom(s) ~'~ ~ Toilet room(s)
Porch, type~- ~ Deck, type ~ Patio, type
Breezeway Garage --- Utility room ---.
Type Heat C~T/¢m<_- Warm Air O~c-~7~Hotwater
Fireplace(s) o~ No. Exits ~ Airconditioning
Domestic hotwater -~ Type heater ~7~
Other
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const....~.~o~'7~,,~
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52 ,
_Location Description Art. Sec.
~-~ i
, - --..~'T~c:.~_.~,~L"I~-.~ - v. .~-'.~- o~
,4.C0
?
Remarks: ~7 ,, /
Inspect ed by: ~y~y)~ iZa~a~_~Insp. ~/~/~-
Time start~/b-~end2.~ ~-~
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 disposel-(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 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 requ ired to prepare a certificate.
C. 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 . .S.e.D.t.e, .m]~.e..~..5.~., .1.9.8.0, ....
New Building ............. Old or Pre-existing Building ., .X. ........ Vacant Land .............
~-~¢Z~3 Private Road off Paradise
location of Property Beach Road Southold
House No, Street Hamlet
Owner or Owners of Property Doris Bruce
County Tax Map No. 1000 Section 081.00 Block 03.00 Lot.. 013.000
Subdivision ................................. Fired 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 .... .X. .................
Fee Submitted $..5 :.0.0. .......................
Construction on above described building and ~p/~,~eets~a~;)~plic. c.c.~c/odes-~ ~'- / ~ ~/ ---'/~'~ and regulations.
Applicant .. ,~..,.,,/' ./'~./_~?~..~ ...........................
~chard F. ~a~, Attorney for Applicant
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