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Home My WebLink AboutZ-9967FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... g996~ ........ Date ....... .M.Sy..3..0 .... ............... 19 ..80. THIS CERTIFIES that the building ................................................ Location of Property .2.9.5.0...l~.:l..~..c~...e..R.o..a.d..(.C..R:..2.7..~) ...... M.8.'~..~.i..t34. c..~s..N,~r. ~Jo' ' '. Street Hamlet County Tax Map No. 1000 Section ..... ~l./*.fl....Block .... .0~ ......... Lot .... 00~.o. 1 ....... Subdivision ............................... Filed Map No ......... Lot No .............. requirements for a one f~mily dwellin~ built prior to conforms substantially to the ~ Certificate of Occupancy Z9967 .... .~.pl?.~.l. ?.~. ....... , 19 5.7.. pursuant to which ~ ...................... dated ..... .M~.]~..~.0. ............... 19.8.0. , 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 toIrene Cardlnsl ..................... ~oYde;,'~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .............. .~./..~ ........................ UNDERWRITERS CERTIFICATE NO ...................... .N./.R ..... '/ ................. / Building Inspector Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location ~¢50 H/z2DL~ ~ d~,/~ fTC) l~/ql'7-zTCZCf--- (n~ber & street) (M~icipality) Subdivision ~ ~ap No. Lot(s) Name of Owner(s) Z~/~ occup cy / (t~e) ~ (o~er-ten~t) A~itted by:~F~a ~ Accomp~ied by: Key available ~ Suffolk Co. T So,ce of request~Z/~//~ - ~13~ Date DWELLING: Type of construction ~--/~d/~;~ #stories /f/~i Foundation ~L/~_ /~/~ Cellar~--~l/ Crawl space Total rooms, 1st. F1 ~'- 2nd. F1 r- 3rd. F1 Bathroom(s) 7--~/~ Toilet room(s) Porch, type ~ Deck, type ~ Patio, type Breezeway ~ Garage --- Utility room Type Heat~Warm Air ~ Hotwater~3/~ Fireplace(s) - No. Exits ~o~ Airconditioning Domestic hotwater Type heater Other ./~/~, ~-/~.c~ (lJc3~3n ' / ACCESSOR~ST__RUCTURES: ,'/~ ~7-v ~ type ~~Storage, type oonst. Swimming pool Guest, type const. Other ~,q/~/~, /Jl,,'z' :;z"~,,~U..,~ ~)m ~-~L c'~zc... VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Remarks:~,f t Inspected by:~~~__Date o~ Insp. Time startZ:~end~: FORM NO. $ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, 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: t. 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 B~lildi~ ~.~;~_.; ...... Addition ................ Old or Pre-existing Building ...... ~ ...... Vacant Land .............. Location Of Property ~.~.~..~..d.~.e.~R..~...a..d.~.C...~..~.2.~7.~).......~...a.~..~.~...~.?.~...~.~..e..~.~.~.~ ................................ Owner Or Owners Of Property ..... ~.P, Tk~...~.~'.~,;~.~3.~, ................................................................................ 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 ........................................ FinaJ Certificate .......................................... Fee Submitted $ .5..:..0...0. .......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ...~.....~ .......................................... IRENE CARDINAL Sworn to before me this .../a ...... day ......... Notary Public ......... ~~ ~, FANNIN(~ " ~ ~IO~MI~-~{J-~LIC, StBte of New Yo~ J~,o. 52-4702t6[ Suffolk Cou_nt~ Term Expires March 30. (stamp or seed MIDDLE ROAD (C. R 27A} MIDDLE ROAD STAT/ON 10~78' ~ .~reO¢ 74 43' 4reO; . ft.' S ~I ft. 4tee'; 2 I,~ 95 ft. AVENUE soUND NOTE: ADJACENT DWELLINGS SHOWN HEREON FOR TAHIR CAN DENIZ,NOV.~'$, 1979 NOTE: I1= MONUMENT REV'S~ONS ,YOUNG & YOUNG NOV. 26,.1979 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG : SURVEY FOR: ~ o'i; ~ AT ~ SUFFOLK CO., N.Y. aY ~_~