HomeMy WebLinkAboutZ-4676FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
Exceptions to Housing ckdes
1. Broken Cellar windol glass
2. couple of roof shingles missLng
3. one asbestos side wall shingle off
THIS CERTIFIES that the building located at .Grl~'e.Drive ........ Street
Map No.l~oydol~ 'ih',' Block No....G ..... Lot No..20. &21 ...... 8ottthold .N,Y.,.
conforms substantially to th R ~ dwe · g cc
~ -'Bui'lt-prior. Apr,., 19. '57 pursuant to which l~~t~.~. .Ztl~76
dated .......... ~lll~e' ' '21'" 19..~, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .Private. one. $ara!l¥. dwel:l&rtg. ......................................
The certificate is issued to . George .&. Yel'maiea. Brudermann .... 0~ners ..........
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .... pre- .existing .................
UNI)ERWRITI~RS CI!RTIFICAT[~ No .... prO- .e~rliting ...............................
IIOUSI. NUMBI!I~,... 3.~'-5 ..... Str,:ct.. G~,ove. DI""I"~t. .Reydon. 8heres ................
Building h~spcctor /
Lots
Housin~ Code Inspection .~f Pre Existin~
George H. & Veronica E. Brudermann
3?5 Grove Drive
Southold, New York
20 and 21, Block G, Reydon Shores
June 20, 1972
About 3:30 P.M. Ed Hindermann and I admitted ourselves
to this unlocked one family dwelling as instructed by owner.
We only noticed a couple minor things. One broken cellar
window pane, couple of roof shingles off and I asbestos side
wall shingle off. Open under front porch (post).
The electric was off. We noticed no other violations.
GHF: tle
George H.
Building
Fisher
Inspector
FO~M NO. 6
TOWN OF SOUTHOLD
Building Delm~tment
Town Clerk~ Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector 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
installations, 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), No~-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property 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 in-
formation required to prepare a certificate.
C. Fees: 1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
$5.00
3. Copy of certificate of occupancy $1.00 ..~.~./.~
Date ...... .~...: ...................
New Building Old or Pre existing Buildin~ ~ --/ Vacant Land ..........
· o,,on O, ...... i:: .....
Owner Or Owners Of Property .~.~.,.~.......~.... '...~..~--------'~v~/~.~.-.-..-~";..~.~'~'"~~'~¢~'''''''~
Subdivision ................................................................ Lot No~.~'. ,/(. ~Block No....~....... House 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 $ ....................................
Construction on above described building and per,~,m te~_.~iH-~licable codes and regulations.
Applicant ~.~~~.,.~ ~ ..........................
Sworn to before me this ~ /~ /
./..~..~day of · ../...~,.../..~.___ L/' (stamp or seal)
No,ary P ¢c Coun
Commission Ex~ires March 30, i9' ~
Lot
2O
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