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Home My WebLink AboutZ-5880FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.Z~8.8-0 ....... Date ........... Na~... 2. ........ , 19 .~.. THIS CERTIFIES that the building located at R,0,~/.o..Peooni0. ]~y. ]~l~t Street Map No..~ ......... Block No.~ ........ Lot No. ~.. ~X..N~X, ............ ~r~q~e~en~s ~o~,~n~ f~ily dwell~g & hous~g e~e conforms substantially to ~ne ....... ~r.t~te_o~nr i te o ~cu BeEore. Aprt$ '2S.., 1~7-- p~su~t to which~No.z~8~O.. dated .......... ~ .... ~ .... , 1~.., was issued, ~d conforms to ~1 of the req~e- ments of the applicable provisions of the law. The occup~cy for which ~is certificate is issued is .Pr~a~e..~ne. ~$~ ~e~$~ ........................ The certificate is issued to . .D~. ~..~k. ~. ~ .~ ................. (owner, lessee or ten,t) of the afores~d building. Suffolk County Dep~tment of Health Approval ~re~..eX~.~ ..................... UNDeRWRITeRS C~RTI~ICAT~ No..pr~..ex~$ ........................... HOUS~ NUMBER . ~70 ........ Street .. peewee. ~ .~ .................... ........... ............... B~lding Insp~or HOUSING CODE INSPECTION April 25, 1974 #4170 Great Peconic Bay Blvd. Laurel, New York Tax Roil: Donald H. & R. C. Clark Occupied Owner Upon request of the Southold Town Building Department I made inspection of this one family framed dwelling and the accessory buildings on premises and found no violations of Chapter 52, Housing Code, Town of Southold. I was admitted by Mr. Clark who accompanied me during inspection which began at approximately 10:30 A.M. Dwelling consists of three bedrooms, two full bathrooms, living room, kitchen, with heat supplied to each room from oil fired hot water furnace in partial cellar. Accessory Buildings are a one room guest cottage (sleeping only), and two car garage with workshop. Inspection completed at approximately 11:00 A.M. Edward Hi~dermann EH:mm FORM NO. 6 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 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 Date ....... ....... New Building ................ Addition ................ Old or Pre-existing Building X~XX Vacant Land .............. Location Of Property .S.../..S. ~..r..~.~..t...P..e..c..o. nic Bay. Blvd. Laurel Owner Or Owners Of Property Donald C~.k & wi~ ........... Subdivision XX ............ 1+1 70 ................................................................ Lot No....x...x. ..... Block No. xx House No ............. Permit No.....~ ...........Date Of Permit ......~ ......... Applicant X~ Health Dept. Approval -.J?.[.e...-....e...x.J'-.sti.n.~....Labor Dept. Approval ............ .N......~... .......................... Underwriters Approval ,?..r..e...-....e..x...i..s..t..~.g. .............. PIo~ Approval .... ~......H..:. .......................... Request For Temporary Certificate ....................... ~..~ Fina I ,~e/i~e ...... ~ ............................ Fee Submitted $ ~'00 /// ~/ Construction on above described bu,lding a.~-r~it ~//p.~able c~gulations. Sworn to before me this J ~ '~ Attorn /~ ~ lfT~ .......... 2.... day of ...~.[~r......1.9.2.~ ................... (stamp or seal) ~/u..c.~ ~. %-~:O Notary Public .................................... County ~~ ~