HomeMy WebLinkAboutZ-9573FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No...Z 95.7.3 ......... Date ................... June..2.7 i .... 19 7 9'
THIS CERTIFIES that the building ................................................
Location of Property ~3ulse~N0o~ $ tr<)hsor~ .Roac~ ,...Cue~l~r~$ .......................
County Tax Map No. 1000 Section .. l 0~ ...... Block ... l 0 .......... Lot ..... 91.7 ........
Subdivision ............ ~XX ............... Filed Map No..XXX .... Lot No .... XXX .......
to
Cee~'lz'$f..i~.te Oc, cl:' ' te of upancy
........ 34aril. ,Z3,.., 19~7.. pursuant to wmcnlll~ltl~tmo ........ :196.7.3 ........
dated ......... June. 2.l, ......... 19 2.9, 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 .........
................ !~.RIUAT'R ,. O/q]~ .-FAMILY..D~i~LL~NG ..............................
The certificate is issued to . John. ~nd. J. une. Col~bkeV,- ......... . ......................
of the aforesaid building.
Suffolk County Department of Health Approval .. RRE.-F_~I.qTING .........................
UNDERWRITERS CERTIFICATE NO .......... l~tl~ .-EXISTING ............ /7(. ..........
/
Rev 4/7B
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
Location
Subdivision
HOUSING CODE INSPECTION REPORT
(number & street) (Municipalit~y)
-- Map No. --- Lot(s)
Name of Owner(s)
Oecup cy
A~itted by:~Accomp~ied by:
Key available Suffolk Co. T~ No./~O
Source of request ~z~ ~ ~ Date
/
DWELLING:
Type of construction
Foundation ~/~'~ ~Z~)Cellar~2
Total rooms, let. Fl'~ ~nd. F1
Bathroom(s) 7~ Toilet room(s)
Porch, type~Deck, type
Breezeway ~ Garage -- Utility room
Type Heat-_~_~___Warm Air
Fireplace(~) ~,~ No. Exits
Domestic hotwater~L/~o~Type heater ~)~z_ ~-/~
Other /
#stories
Crawl sPace~
3rd. F1
ACCESSORY STRUCTURES:
.~' c~.~..
Garage, type const.~Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Remarks: /(~0 ~/~ O / A 770/./_~
Inspected by:~ ~~ate of Insp.~
Time start/,'/~ ~, end /: Z~- ~
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 featu res.
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.
B. 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.
C. 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....-~..~, ~, .~,. ~, )~.../. ,~... :..
Building ............. Old or Pre-existing Building . (~f.~... Vacant Land .... V' ........
Location of Property../'..~.~. ........... .~..~..t~.....~....~..~...~. .... '..~.?...~ ........... .~.?..t .~.~.~/o~.~.~
O ner or O ners of Proper y ....................
Count Tax Ma o 1 - ~'43'_~'
y p N . 000Section ............... Block .... ~. .~. .......... Lot .(~..z. ~ ..........
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 $ ' ' f' '~'~' ............. ~U'f
Construction on above described building a~..~: ~nr~-~, a./~p, lic~nd regulations'
Applicant~...'~...~c~C..,..~~ .~. ....................
J
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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all p~operty 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 requ ired to prepare a certificate.
C. 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 ...J~-~..26,..],979 ........
New Building ............. Old or Pre-existing Building ...X ........ Vacant Land .............
Location of Property . .S/S...Str13~8on. ,-q, Qad~..C~tf-C~O~[QP~,..~Te~ .York ..................
House No. Street Ham/et
Owner or Owners of Property . . . .~.o.h.q, .&..~q .~.e..C.o..~.~.~.e.~ ..................................
County Tax Map No. 1000 Section ...[.0..3 ......... Block . . . .[.0. ......... Lot...]-.7, ...........
Subdivision ................................. Map No ............... Lot No ...............
Permit No ........... Date of Permit .......... Applicant .... G..o.h..~..qo..~.~.[.e.~' ................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ... ~: ..................
Fee Submitted $.. 5...QQ ......................
Rru~olph HY Bruer, attorney for John Corbley