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Home My WebLink AboutZ-10119FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z10119 Date ......... AUg...8.~...29 .............. 19. ~.0 THIS CERTIFIES that the building ................................................ Location of Property 7'19 O~d~ .8. ~;:~.0.~.$ .... QU.~.~hOgll.e,..N,~. ..... h3~ ~. ' ........... ~ie3i ..... Hamlet County Tax Map No. 1000 ~ction ..... ~.~ .... Block ... J ........... Lot ..... ~ ......... Subdivision .~g~e. H~g~ .............. Filed Map No..85fi .... Lot No...20....~1... re~rem~nt~, ~or ~ o~-f~lly~.,d~el~3~g ~ui~ prior to confoms substanti~ly to ~e ~g~m~~m~a~a~a~~ ~r~.ca~e ~ .Occup~cy . . ~r~..25 .......... 19 .STpursuant to ~a~mu~a ............ Z3OJfi.9... dated ...A..ugh..s.t..2.9 ............... 19 .~.Q, 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 ......... ..... .................................................... The certificate is issued to ....... ~..q .h~., .~..~pp~.a. ...................................... (owner, I~Ji~r~g of the aforesaid building. Suffolk County Department of Health Approval . . .I?./.R. ................................... UNDERWRITERS CERTIFICATE NO ........... N../.R. ................................... Building Inspector Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT · (number & street) Name of Owner(s) ~A/~ 4~ ~--~/~Z~-/~ Occupancy /~-- f (type) Admitted by: (MunicilYality~ / '<~'-6" Lot(s) 70--7/ (owner-~e~m~) Accompanied by: Key available Suffolk Co. Source of request~~/~) ~_~ Tax No./~,~- t~g-Ol-OYz- Date_~C ~ '~3 / DWELLING: Type of construction Foundation ~L ~_~--7-~ Total rooms, 1st. F1 Bathroom(s) ~ Porch, type Breezeway ~-f-g~ #stories~-/~ Cellar~ Crawl space'~T~_- ~ 2nd. F1 W~/ 3rd. F1 Toilet room(s) Deck, type Patio, typ~ Garage Utility room Type Heat~Narm Air O,~f~Hotwater Fireplace(s) No. Exits _~ Airconditioning Domestic hotwater ,/~. Type heater / Other ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other Storage, type const. Guest, type const. VIOLATIONS: HousingCode, Chapter 52 Location Description Art. Sec. Time start end FOI{I~ NO, 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southoid, 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 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 New Building ................ Addition ................ Old or Pre-existing Building .....~ ...... Vacant Land .............. Owner Or Owners.,Of Property .......~..J,,.~..~.~....~..~...R..~..~'~ ................................... Subd,v,s,on Lot ......... 3lock No ............. House No ............. Permit No ..................... Date Of Permit .................... App[icant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Plann.~Board Approval ........................................ Request For Temporary Certificate ............................ ~.~Z~ .... Final Certificate .~'.... __~l~ /' ~ --~ ................................. Fee Submitted $ ....... J~..~,~ .......... Applicant .. . 'i ~./...~.~.~.~./~...~ .............................. ................ day of ............................................ (stamp or seal) Notary Public .................................... County 0 b 0 ,[ Tow~ c~ scA: