HomeMy WebLinkAboutZ-10234FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y. ·
Certificate Of Occupancy
No...~.1.0.~ ~./4 ......... Date .... Ng.v.e.m..~.e.z]..~., ................ 19 .~.0.
THIS CERTIFIES that the building 8 ...............................................
Location of Property .... ? 775..~ai.t.h. Dr~,v.e. Ro~.th ....... S.o.~th.old,. R,.¥, .........
House No. Street Ham/et
County Tax Map No. ]000 Section .. O~.6 ...... Block .... 03 ........ ]Lot ... 002 ..........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the ~]~i~.~[ '~g.~_~'fl~.~.J~t~]:l~~i_Or
to
C~rSc~f&c at§~.~o .f+ ~ccupancy
·..~.p.r.i.1..2.5 ......... ,195.7. pursuant to wmcn *~-~rm:...~ ......... #Z10234
dated .... No¥smber. ~ ............ ]9.80, was issued, and conforms to aH of the requirements
of the applicable provisions of the ]aw. The occupancy for which th~s cert~Mcate ~s issued is
of the aforesaid buildLng.
Suffolk County Department of Health Approval ...~/~ ...................................
UNDERWRITERS CERTIFICATE NO ........... ~T/p~ .... , _...,.. _/. ................
Rev 4/79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location /775 ~/~'~/~.
(number & street)
Subdivision~m~/5/~/~
Name of Owner(s)
(Municipality)
Occupancy
Admitted by:
ype)
Key available
Source of request
( owner-tenant
Accompanied by:
Suffolk Co. Tax
DWELLING:
Type of construction
Foundation ~U~,~x~ ~C/~"' Cellar~/~-/~
Total rooms, 1st. Fl~-
#stories aL ,/~/~-~,
Crawl space~
~rd. Fi ~
Bathroom(s)
Porch, type~¢-/~=~_~ Deck, type
Breezeway. Garage --
Type Heat ~5,~/~.__ Warm Air
Fireplace(s) ~,0~- No. Exits
Domestic hotwater
Other
Toilet room(s). -
Patio, type -
Utility room
Hotwater ~zc_ ~-/~
Airconditioning ~
Type heater~/~ ~_~
ACCESSORY STRUCTURES: /
Garage, type const. ~-/~Storage, type const.
Swimming pool -- Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
.,Location Description Art. Sec.
/ / f
FORM NO. 6
TOWN OF $OUTHOLD
Building DepaH~.ent
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 usa:
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 usas, or buildings and "pre-existing"
land usas:
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 usa, 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 $5.00
3. Copy of certificate of occupancy $1.00
2ate /g) .~0 ..~'?
New Building ............. Old or Pre-existing Building , v/ Vacant Land
Location of Property .~....~./?~..~...~y~.~..A~..'...~.~.,.t/.-~.:..~..D...t'~.. ............... ~.O....~. ?./d
Owner or Owners of Property ~. t!1.~.~....~..~.C~W. ..........................
07~ O~
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ..~, .0.0..~..~..I/),~,, .~. ,~-. ............... 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 per t meets all applicable codes and regulations
.,~.,o-,o-,a TOWN & COUNTRY ABSTRACT LTD