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HomeMy WebLinkAboutZ-4874FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy NO. Z ; ~ ..... Date ............... 0¢%...2~ .... , 191 THIS CERTIFIES that the building located at ...W/8.. Depot .l~tne ...... Street Map No.. :/~ ........ Block No...:lr~ ..... Lot No.. lr, x,X....~uteho~-~...Ii ,Y4 ....... conforms substantially to the eq i~.~ t~ f.. f 1 d ~ .& mi l~ll~[ljl~f~r,.~r!!. ~ ..... , 19.~?. pursuant to which ~ *~o. dated .......... 0¢teher.. 21~., 19. ~/2, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pl~:kvafce .one..family. dwa11Lug. & .aeeasso~..B~ldLu~D, ~ss. ~ ) The certificate is issued to ~lex .&. Bertha. ~anowak~... ~ers ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Pre~ .ex,at,rig ................... UNDERWRITERS C[RTIFICAT~ No... p.~O~OX~g ................................ HOUSE NUMBER.. ~.~ ....... StreeL .DepOt .~ ................................... / Building Inspector HOUSING CODE INSPECTION October 24, 1972 /70- Depot Lane Cutchogue, N.Y. Tax Roil: Alex J. and Bertha H. Danowski Unoccupied Upon request of the Southold Town Building Department I made inspection of this one and one half story, three bedroom framed dwelling and found one violation of Local Law #1, Housing Code of the Town of Southold. Robert Krupski of the Russell P. Sillick Agency gave me the keys which I returned to their office upon completion of inspection. Inspection began at approximately 2:35 p.m., completed at approximately 2:55 p.m. Violation: kitchen, there is no shut off valve at gas range - Section 505b.  dwa~Hfully submit~ted, Inspector EH:tle FOB, M NO. 6 TOWN OF SOUTHOLD Building Deporl*ment Town Clerks Office Southold, N. Y. 11971 APPLtCATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 dispcsal--(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 cornpiionce 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 3. Copy of certificate of occupancy $1.00 $5.00 ¥/'7 Date ................ ~.. ......... 7 ................... Notary Public, Slale of New York No. 52-0344963 SuffoLk Count C~'mJssJor~ Expires March 30, 19~ (stamp or seal) New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Locat on Of Property ~J....~ .......... ~ ~ Owner Or Owners Of Property ....~......~.../~......~.....!..~~....~.~' Subd v s on ................ ~ ........................................... Lot No ...... ..~..~...t,' Block No.......,~,.... House No ............. Permit No .......... ~ ......Date Of Permit ...... ...~.. ......... Applicant Health Dept. Approval /..~..,~..c~ c~qc,~-~z~ Labor Dept. Approval ......... ~ ................................. Underwriters Approval ...... !~..'.~.'.-......Z..~. ........... Planning Board Approval .~..;..~,. Request For Temporary Certificate ........................................ Final Certificate .......................................... ......................................... Sworn ,o before me this ~ ............................ ~7'"~ ..................