HomeMy WebLinkAboutZ-9727FORM NO. 4
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Occupancy
No...Z97Z7 .........
Date ...... 0c.~ober. 21, ............... 19.7.9
THIS CERTIFIES that the building ............ ~ ...................................
LocationofProperty 5~5 King.~tre~t & 1120 Third Street .N..~.W. ~l.;~olk
House No. S~raet Hamlet
County Tax Map No. 1000 Section ....~.'1.7. ..... Block ..... ~ ....... Lot .... 0.1.~. .........
Subdivision ............................... Filed Map No ......... Lot No ..............
Reguirements for a or~e family to
conforms substantially to the dwelling b~. tit ,orior
certificate of Occupancy ZC),727
...ARr..1.1. ~ .......... 1~.7... pursuant towhic~. '
dated .... .O.q~:o.b.e.r.. ~.~. ........... 19.7.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 .........
.................... p.n.q, F.a.m.i.!y...'~. e. !.l.i.n.~:. w/Acc ~:s.~ory'..Garage ..............
The certificate is issued to ......... ~,teJc~v~..t~,. (~R~ ...............................
of ~e ~o~ b~d~g.
Suffo& County ~pmhn~t of He~th Appm~ ................... ~ ...................
~ERWR~ERS ~RTIFI~TE NO ........................... ~ ...................
· BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ~-~-
(number & street) · (M~icipali~)
Subdivision ~ Map No. Lot(s)
Name of Owner(s) M,~7-O~/~ ~. C~
Occupancy
(type)
(owner-tenant)
Accompanied by: ~
Key available
Suffolk Co. Tax No./~o-~7-07,0~7
Source of request
DWELLING:
Type of construction /~oO~ ~;-~
Foundation ~,~ ~w~-~f~t~/c~ Cellar fa~//
#stories /
Crawl space
Totalrooms,, 1st. F1 ~ 2nd. F1 ~ ~ 3rd. F1
BathroomI~ ~ ~ ~o~ -~ Toilet room(s)
Porch, type~Deck, type. Patio, type.
Breezeway Garage Utility room
Type Heat o~- ~-~/~m 'Warm Air z~~Hotwater
Fireplace (s) · No. Exits ~---~ O Airconditioning
Domestic hotwater Type heater .C7~
Other
ACCESSORY STRUCTURES:
Garage, type const. LOoom~/~ Storage, type const.
SwNmming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Remarks:
Inspected by
Date of Insp.~cTZ~,
Time startZ~, end
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
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 Inspec-
tor 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 installa-
tions, 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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 building[
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date G .~. ~..~.~, 1.~ .~.q...
New Building ............. Old or Pre-existing Building .... .~. ...... Vacant Land .............
Location of Prope ..........
House No. Street Hamlet
Owner or Owners of Property .. {~ ~r.{~,~.~l ~. L~....~.'...~ k~ .~'., ..........................
County Tax Map No. 1000 Section .... ~.~.?. ..... Block ...~. 7 ........ Lot...~. ~'.'7 .........
Subdivision ................................. Filed Map No ........... Lot 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 $... ~'~ .~.0.. ....................
Construction on above described building and(~r,rni, t2.e.e,~l applicable codes and regulations.
Applicant .... ~N~X,~.~, . ~. ! ....... - '-' ~'~ ~'?-1'~
Rev. 10-10-78