HomeMy WebLinkAboutZ-10310FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
........ ~ e .!7, ................
No..ZJl~310. Date ...1;)¢.o. yCp¢~'. 19.8.0
THIS CERTIFIES that the building ................................................
Location of Property ...fi5905... ~IOj..vl. Ros~cl ............ SOIAt;hO'I cl ...................
House No. Street Hamlet
County Tax Map No. 1000 Section .. 1~3 ....... Block ... lQ3 ......... Lot ... J08 ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
.R~oulremen~a, for.a One F~m~lv_, Dwellin~o~uil~ ,Prior to
conforms substantially,.to the
...~.p.r.i.1.. ~,3., ........ , 19~7. pursuanFteo~w~fic~~8.II.e.Y... Z..lO}.'lfl ......
dated .. J~oo.elllb~l'. ~.7. ............ 19.80, 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 .........
............. .o.n. ~. F.~.,~.~.~.y...~..e.Z.z.~.n.g. ~..~.h...'~..o..c.~.r.. ?.o.,. ?.~.~.o.' :.~.. 9.~'.*¢~ ......
The certificate is issued to ....E.d.J:..~.13..T.:. ¢9.q .h..f..a.~..E..s.l;.a.t.~ ............................
of the aforesaid building.
Suffolk County Department of Health Approval .... N./R. ..................................
UNDERWRITERS CERTIFICATE NO ...... 1~/I:1 ........................................
Rev 4/79
BUILDING DEPARTMENT
TO¥~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 55905 Main Road,
(number & street)
Subdivision
Map No.
Southold
(Municipality)
Lot(s)
Name of O~er(s) Edith T. Cochran Estate
Occupancy, ~-1
(type)
Admitted by: Mrs. Davids
Ten ant
(owner-tenant)
Accompanied by: Mrs. Davids
Key available
Suffolk Co. Tax No. ~3-O3-08
Source of request R G. Terry Jr.
Date 12/16/80
D%fELLING:
Type of construction Wood
Foundation Cement Block
Total rooms, 1st. F1 3
Bathroom(s) 1
Porch, type glassed in ..~eck,
Breezeway. Garage
Type Heat Oil Fired Warm Air Steam
Fireplace(s). No. Exits. 3
Domestic hotwater Yes
Cellar Full
2nd. F1 4
Toilet room(s)
type.
#stories 2
Crawl space
3rd. F1
1
Patio, type
.Utility room
Hotwater
Airconditioning.
Type heater Gas
Other
large attic
ACCESSORY STRUCTURES:
Garage, type const. 2 Car Wood
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Lqcation Description Art. Sec.
Kitchen Gas Stove no shut off V 52-52B-2
Remarks:
Curtis Horton
Date of Insp. Dec 17. 1980
Time start 2:20 end 2;~0
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. 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 featu res.
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 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
Data
New Building ............. Old or Pre-existing Building ~.. ......... Vacant La~d ........
Location of Property ......... ~....~.. ........................ ~ .....
Owner or Owners of Property ~--~., ?. .......... .~'.. ~i~ .................
County Tax Map No. 1000 Section ..... ~. ~..~. ..... Block .... . .--~.. ........ Lot ...... P ........
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 $. ~,. ........................
Construction on above described building and permit meets all applicable codes and regulations.
Appheant ........... ~. ..........
Rev. 10-10-78