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Home My WebLink AboutZ-9745FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Date November 8 19..7..9 THIS CERTIFIES that the building ................................................ 11365 Location of Property Sourld Avenue l¥1~tti~h, ick, County Tax Map No. 1000 Section ... ~ ..... Block ...... Q~ ....... Lot ...... QO~ ........ Subdivision ............................... Filed Map No ......... Lot No .............. requiremente for a one family dwelling built prior to con~rmssubstantiflly to ~e ,fioate of Occupancy ..................... Z97~5 April 2~ ,19.~Tpursuantto which~o ...................... dated ....N.o.y.e.~.b.e.P...8. ............19.7.9, 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 ......... ...................... .~Lv.a.~ .e..~. e.. ?..~J, .~y...m*..e!!tn.g .......................... The certificate is issued to Irene R. Cardinal ..................... io¥,,'~), '~~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ............ .~../R .......................... Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location II~ (number & street) Subdivision Name of Owner(s) Occupancy (type) Admitted by: /~- Key available Source of request .Map No. (Municipality) Lot(s) tenant/ Accomp~ied by: ~ Suffolk Co. T~ No./~O- ~C~ ~ ~F~/ Date DWELLING: Type of construction /,oOo~--~,c~'~= Total rooms, 1st. F1 ~ 2nd. Fl~z~ #stories Crawl space~7~_ Bathroom(~ ~/g ~r~o/~,__Toilet room(s). Porch, type~/~~. Deck, type ~-- Patio, type. -- Breezeway --- Garage ~-~ Utility room ~ Type Heat~/~. Warm Air ~ ~c~F~ Hotwater ~ Fireplace(~.~.~ No. Exits 7--~00 Airconditioning Domestic hotwater ~ ~ype heater ,~,47~-~ Other ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Remarks: . / Inspected byt~/~y-~6~~ate of Insp. ~cA/ Time start~r~-~M, end ~.-/o FO]gM NO. 8 TOWN OF $OUTHOLD Building Department Town 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 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), 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: ,,j~Certificate of occupancy $5.00 f~'Certificate of occupancy on pre-existing dwelling or land use~ $5.00 ...... ~ 4..~...? ~.. 3. Copy of certificate of occupancy $1.00 / Date /O ~. ......................... New Building ................... ~,OId or Pre-existin~g Building ............................ Vacant Land ............................ Location Of Property .....~..~.~..~.'..~;....~...../~...~....~....../~....C/....~.! ....... ...~.....~...~.'..:~..i.'...~...O....~.....~....../.....~.....~... Owner Or Owners Of Property ~...~.~.~`~./~..~..~..~.~`..~=~.~(..~.~./..%.~.~.~/.~..N...~.r~.~.'~=.. ............................................ 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 permit meets all applicable code,~ 9rid regulations. Applicant ............ .,/. ........ r ................. Sworn to before me this .....~...~..... day of .1~..~~?../.~...7~ (stamp or seal) NptaFy Public ....... ,1Ht~Fr.N C. formerly or cordin°l irene N0££ · ~ MONUM£NF ~/?L£ NO 7908 -0~497 now irene formefly or cardinal 4reO ,21,395 r~ ft' CHICAGO TITLE INSUR~,~CE formerly now ~°rBerdint<° joseP' AVEI'jUE SURVEY FOR $1~LV~TOt~E J. $~N$ONE AT MA ?"F/TUCK TOWN OF SUFFOLK COUNTY, NEW YORK YOUNG YOUNG ALDEN W YOUNG,PROFESSIONAL ENGINEER AND LAND SURVEYOR NYS UCENSE NO I2845 HOWARD W YOUNG, LAND SURVEYOR OATE ~ 00~ 2,.~ , /979 SCALE: / -- 4/0 NO ; 79 -6// 400 OSiRANOER AVENUE RIVERHEAD, N,f-]W YORK