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HomeMy WebLinkAboutZ-11169FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g 1 1.1.6.9 ......... Date ...... .S.e.p..~.e.~.b.e. ?..3 ....... 19.8.2. THIS CERTIFIES that the building g ....... ( 2 ) .............................. Location o f Property . 6 8 D. .................. R ~ ~ ]~ ;L.~. [, ~t.a.e. ........... E a a 1;../~ a r Lan... House No. Street Ham/et County Tax Map No. ]000 Section ... D~I. ..... Block ... J ~ .......... Lot . .0..1 ~ ............ Subdivision..g ............................ Filed Map No..X. ...... Lot No. X Requ~.vement.$ for a pr',.vat, e one-fam:Lly dwell:Ln& bu~.lt, prior t.o conforms substantially to the ~'A4ap~ie-at~ien.4`er"~K~8~;~em~i~4'~e~e~fem-Fde&~n~-fl~s~ffi~e-d-~ed Cert,~.ft. cat, e of Occupancy .... Apr.L].. 23 ........ , ]95 ?. pursuant to which ]~4dieg. l~en~ii No... Z. 1. 1 ] 69. ........... dated ..... Se p.t, ember..3 .......... 19.6.2, 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 ......... .... a. seaso~l ~.e.-..f.a.m. ily dwellin~ and one accessory storage bu:~lding. The certificate is issued to ......... J).q~$1d M, C~.riack$ ...... ..................... of the aforesaid building. Suffolk County Department of Health Approval Ia/.~.... UNDERWRITERS CERTIFICATE NO .......... B/.I: ..... Building Inspector Re~. 1/81 BUILDING DEPART~tENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location ~//~Y~ ~ ~ h~°~ (number & street) ~' (M~icipality) Subdivision ~ap No. Lot (s) N~e Of Owner(s) g~ , Z~/~ (type) ~owner-ten~t~ A~itted by: ~ Accomp~ied by: ~ Key available - Source of request~J/~ Suffolk Co. Tax No. ~ (- ~ / ~/ DWELLING: Type of constru /~/g~( #stories Foundation ~o~ ~,~ Cellar Crawl spaoe Total rooms, 1st. F1 ~7~ ~7~ 2nd. FI_ -- 3rd. F1 Bathroom(s) Toilet room(s) / Porch, t~e ~ Deck, t~e ~J ~a Patio, t~e Breezeway ~ Garage ~- Utility room Type Heat ~ ~Warm Air -~ Hotwater Fireplace(s) ~ No. ~i'ts ~ Airconditioning Domestic hotwater ~/~ ~e heater Other ACCESSORY STRUCTURES: ~arage, type const. Swimming pool Other '- - Storage, type const. ~/~ Guest, type const. U[0LATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Remarks: Inspected by: /~f~ ~~ Date of I nsp. Time start 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 ~nd 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 unusua~ 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 ~remises, 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 August 3, 1982 Seasonal New Building ............. Old or Pre-existing/Building .... ??. ..... Vacant Land ............. Location of Property ....~...~..0. ........ R. ~,~.~.~.. ~.a.~.e. ............... .~.a.s. ~_..~ario~ ....... House No. Street Hamlet Owner or Owners of Property ....... .D.o.~a. ~.¢..H.:. ~.~.~..a .c~? ............................... County Tax Map No. 1000 Section . . . .0.3.]: ........ Block ...... .0~.8 ...... Lot .... 0..1.5 ......... 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 ...... X.~ ............... Fee Submitted $. ~...0.0. .......................