HomeMy WebLinkAboutZ-11119FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inqaector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.~l ] .1.1.9. .......... Date ..... AP~U~ ~..6. .................. 19 02.
THIS CERTIFIES that the building .-.. {i~.t. aCbl~l,,, l;hr. ee .-c~,r. ga~.~go ..............
Location of Property . 2.1,,~ .............. $J, xab. ~,~p.e. ............... ~jc~9rsp.q~. ~,...
House 61o. Street Hamlet
County Tax Map No. 1000 Section . 0.~2. ....... Block .. 0.1 ........... Lot.. 02~ ...........
Subdivision .~lao~aa. ?r.:Lce. $~.. ga.t~$ea...Filed Map No. @~ .1 ..... Lot No. ~a ..........
Requ~.rement;a £oe. p~;Lv,a.t;e BRra&ea,.bu~klt; .prxor~co
cunfoms subst~t~ly to me
Certificate of Occupancy
...Apr~ .2~ .......... 195 ?. pm~nt to wMch ~~ No ....... g.Ll.l 1 ~ ........
dated .... Augur:. 6 ............... 1~2., ~ i~u~, ~d c~f~s to ~ of~e ~u~ments
of the app~ble prov~io~ of the law. ~e occupancy for wMch tMs ce~ificate ~ i~ is .........
...a. ~[~r.~ ~R~. O~.~R¢ ~r.~ .gor.RGe, ............................................
~e ~ificate is ~ued to .......... ~ugl~a. Y~..G~arX .............................
of the afore~d b~g.
Suffo& County ~p~m~t of HeMth App~l ..... ~r .................................
~ERWRITERS CERTIFICATE NO ............. ~r .................................
Building Inspector
1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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. Fi~lal 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 certificates of Code c_ompliance from the Architect or Engineer responsible for the building.
5. Submit Planning ~oard apprOVal of completed site plan requirements where applicable.
For existing buildi.~gs (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 0f owner or previous owner as to use, o~:cupancy and condition of buildings.
3. Date of any hou~ng 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
$5.00
Date June 2, 1982
X×
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
215 Sixth Avenue Greenport
Location of Property ...................................................................
House No. Street Hamlet
Douglas V. Clark
Owner or Owners of Property ............................................................
County Tax Map NO. 1000 Section 042 Block 01 Lot. 02 8
Subdivision /.~.A~$....~f/: .C~......~.~.. '~.-...~il~d Map No..~..~. ! .... Lot NO....~.'.Q-..f-~ . . .
Permit No: .......... Date of Permit .......... Applicant ............................... (~
Health DePt. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporar~ Certificate ..................... Final Certificate .......................
Fee Submitted$ 5.00
C~..C3 :~c [ [ ( ( q Applicant.......'~y~'~..:..~./.,~_~..,.~. ......................
/~/~.-~ ~ Irvin~ L. Price, Jr. A~orney/Agent for
Rev 10-~7-'~~F- O~(~--~..~ Douglas V. Clark
BUILDING DEPARTmeNT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ~ / 5 -- ~ ~ A
(number & street)
ou Wo on
Name of Owner(s)
~T~6 & ~6(~o ~l
(Municipality)
Map No. -~',~"/ Lot(s)..,~
Occupancy
(type)
Admitted
Key available
(owner-tenant)
Accompanied by: 'b~o ~
Suffolk Co. Tax No. fO0~-
Source of request
Date ~/~ o_~
Type of construction #stories
Foundation Cellar Crawl space
Total rooms, 1st. Fi 2nd. FI 3rd. FI
Bathroom(s). Toilet room(s)
Porch, type Deck, typq Patio, typq__
Breezeway. Garagq Utility room
Type Heat Warm Air Hotwater
Fireplace(s) No. Exits Airconditioning
Domestic hotwater
Other
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
,Type heater
Storage,
Guest,
type const.
type const.
VIOLATIONS: Housing Code, Chapter 52
,,,Location Description Art. Sec.
Remarks:
Inspected by:
Date of Insp.
Time start
end ( ~ ~ 6,
75wt-,., 0~: PoJ-rl4of_O,
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