HomeMy WebLinkAboutZ-9554FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Date ...... .J...urn...e., .Q .................. 19..7.9
THIS CERTIFIES that the building ................................................
Location of Property ~t~t~s?'O'6ato ,r
.7.5....~.a.~.n...P,a... ......................... Or. le,.%..~1. ~,..
· Street Ham/et
County Tax Map No. 1000 Section . . .0.1t~ ...... Block ..... 02 ........ Lot ...... 00.'1 ........
Subdivision ............................... Filed Map No ......... Lot No ..............
REOUIR~[E.~TS FOR ONE FAMILY DWELLING BUILT P?.IOR TO
conforms substantially to the ~
·· ,~ CHRTIFICATE OF OCCUPANCY
.g.p.r.z~.. ? .. ........ ,19.57. pursuant to which ~ No ............ .Z9,5.5./4. ....
dated .... .J.uD.e....~ ................ 19.79, 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 .........
Private One Family ~elt~ng with Accessory Structure
The certificate is issued to ............ .Hg.l.e.n., .H:., .BgF.d.e.n' .............................
(owner,~
of the aforesaid building.
Suffolk County Department of Health Approval ............. I~1/1~ .... Pr.e.-.EXlatlng ........
UNDERWRITERS CERTIFICATE NO .... N/R ..... P.r e.-2 '.x. is ting ......................
/
Building Inspector
Rev 4/79
BUILDING DEPARTMENT
TO~N OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location .~0g/7-5~ /-'/~//~0 /~' ~/~
(n~ber ~ street) (M~icipality)
Subdivision ~ Map No. Lot(s)
Name of Owner(s)
Occupancy /~--/
(type)
Admitted by: ~.~ ~)z~/¥$ ~/~/'
owne~-tenant)
Accompanied by: ~/~/~
Key available
Suffolk Co. Tax No./gT~.~-Oz%Z-O~?d)o/
Source of request -~,c~/~ ~o~/
Date ~ - ~ r 7~,
DWELLING:
Type of construction
Foundation~ J ~a~ ~ C. Cellar~F~.
Total rooms, lst./F1
#stories
Crawl space ~,~7'~-..
Bathroom(s)
Porch, type~--ooF~o~- Deck, type
Breezeway .... Garage ~
Type Heat ~z-- "Warm Air --
Fireplace(s) -g No. Exits ~'
Domestic hotwate~r~/~f%Type heater
Other
7~-~ ~& Toilet room(s)
-- Patio, type
Utility
Airconditioning
ACCESSORY STRUCTURES:
Garage, type const.
Swimming poo~
Other
Storage, type
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Remarks: ~ ~-~
Inspected by: _ 22~ZZ~Date of Insp._ ~/~/~Z: 7 ' 7~
Time startS"g~/q, end ~:s~5- ~.~.
TOWN OF SOUTHOLD
, Building Depe~ment
Towe Clerks Office
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
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), Non-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
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 ....... ...~...~....2..~ !...i ~.~. 7.. ?. ............
New Bt~ilding ................ Addition ................ Old or Pre-existing Building X Vacant Land
Location Of Property Main Road, Orient, NY
Owner Or Owners Of Property Whitcom Investment Company
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No ..................... Dote Of Permit .................... Applicant .....~.~.?..~.~.~..d....~..'.....C.~.O...~.Z....~...~..q..*. ............
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporan/Certificate ........................................ FinaJ Certificate X
Fee Submitted $ .5.00
Canstruction on above described building and p~m n~qJ~/~ic~g~e~~gulations.
~ ~ ef ~t: c o m Inv es tmen t C omp a n y
Sworn to before me this / ~ ~'~ / / / ~
, y o ................ .~ ................... (stamp or seal) V
Notary P~lic ............. County JANE FLATLEY ~'/7
NOTARY PUBLIC, State of New York ~ '
/~/ ~,'¢ No. 52'4665418 Suffok County