HomeMy WebLinkAboutZ-10218FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No .... .z?.°.a.!P .......
Date ...... .0.o.t.o.b. 07..~.8. .............. ,19. ~.0
THIS CERTIFIES that the building ................................................
· rt 9100 F, AI~ ROAD ~..ASg ~IO~ N.Y.
Location of Prope y ....................................................... ~ .......
House No. Street Ham/et
County Tax Map No. ] 000 Section ....3.1 ....... Block .....~ .......... Lot ........ ~ ........
Subdivision ................ ; .............. Filed Map No ......... Lot No.
requl, t, ement;s ~0~' a one family dw®lllag ~'i~' ~{&~ to
confo~s substanti~ly to ~e ~~~
Oe~tftcate of Ooeup~no7
....... ~. 2.~ .... , 19 .~7 pursuant to wMch~o ......... ~J.0~ P ......
dated ... 9~9~ .a0 ............. ~9 O.q, was issued, and conforms to aa of the requkements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
......... ~ .~..-.~.x.;~..?~a.. 9.~..~.a.~..~.¥..~..,.~..x~q ................................
The certificate is issued to RAXI40IID C.
..................... /o¥,,;;~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev 4/79
Location
Subdivision
Name of Ovmer(s)
BUILDING DEPAR~~T
TOWN 0P SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(number &-street) '
Map No.
(Mtmicipality) '
Lot(s)
Occupancy ~ty~e~)
Admitted by:. ~
Key available__
Source of request
(owner-tenant)
Accompanied by:
Suffolk Co. No.
DWELLING:
Type of construction
Foundation ~
Total rooms, 1st. F1
Bathroom(s) ~
Cellar~Crawl space___~zm~Z~z~
2nd. F1 ~._ 3rd. F1
Toilet room(s)
Porch, type~.~.~/~.~t Deck, type~.~.~.~. Patio, type
Breezewa~ Garage Utility room ~
Type Heat.~/~z~/~ Warm Air Hotwater /
Fireplace's) ~ No. Exits Airconditioning
Domestic hotwater ~.~. Type h~ater
ACCESSORY STRUCTURES: '
Garage, type const.
Swimming pool/-~~
Other
Storage, type const.~=~.~~[
Guest, type const.
~.~OLATIONS: Housing Code, Chapter 52
, Location Description Art. .Sec.
Inspected by.. ~ Date of Insp.
· ~ j~~ Time start
l~OK~I NO. 6
TOWN OF $OUTHOLD
Building Deportment
Town Clerks Office
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
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 disposol--(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 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 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:
]. 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
Date .J...u..1. Z...?..8...'.... 1...9..8..0. .................
New Building ................ Addition ................ Old or Pre-existing Building ...;~ ........Vacant Land ....X...X. ......
ioo
Location Of Prnn, r~, Main Road, East Marion New York
Owner Or Owners Of Property R.~3T~.Q. nd Dean and Jean Ellen Dean
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No ..................... Date Of Permit .................... Applicant ..................................................................
Heolth Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Cert f cate ..................................... F.na Cert.f.cote ...... X..X. ...............................
Fee Submitted $ 5...Q.O ...... ..................... /~
Construction on above described building and ~erm~t ~eets all a~lic(~/bl~'~'c~es and/regulations.
Applicant ............... ......... .V.. ~.~~.....'~....~.....
Stankevich, Esq.
Sworn to before me this George C.
................ day of July, 1980.
Notary Public ............ .S..u..f. ~ .o..1..k.. ....... County
(stamp or seal)
0.6.
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