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HomeMy WebLinkAboutZ-7763FO~M NO. 4 TOWN OF SOUTHOLD BIJ'ILDING DEPARTMENT Town (]Jerk's Office Southold, N. Y. Certificate Of Occupancy No.~.~. 3. ...... Date ............. ....~.....~..., 19..~'. THIS CERTIFIES that the building located at . ~/8..C3,at'K ~llOa~ ......... Street Map No..XX. .......... Block No. ,:gX ....... Lot No, . XX... 5o~tho].4.. ],]f, ......... l, equ~r~ment~ fo..~ o~ Sm~..ly dwellSn~ 1milt conforms substantially to the ........... Ce~fSea~ of ~aup~y dated .. ~o~ .Ap~...~..., 19.~. p~suant to whi~ ~No.~... dated ........... J~Y...~..., 19~.., was issued, ~d confoms to ~ of the r~ ments of ~e applicable pro~sions of the law. The occup~cy for whi~ ~ ce~ificate ~ issued is . pr~Yat~..on~, f~$!~, d~.!~g ........... ~ aP~Tgy~. ~[ .~. ~.~) The certificate is issued to . .~gare~..~...~r..of. r.ecor~ ............. (owner, lessee or tenet ) of the aforesaid building. S~olk County Department of He~th Approval ~r$~. 9~s~ ..................... UNDERWRITERS CERTIFICATE No..p~..e~a~g ............................ HOUSE NUMBER ..... ~ ..... Street . C~.~. ~Q~d ............ ~ ....... Building Inspector 4 .1 .1 PO~M NO. S TOWN OF SOUTHOLD Building DelMr~ment Town Clerks Office Southold, N. Y, 11971 APPLIGATION FOR GERTIFIGATE OF OCCUPANC:Y 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 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 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: 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 $1.00 Dote ...$.../.T.'"f....T...'TL......~,.......:...(../... New Building .................... Old or Pre-existing Building ...... ..4~.......,... ......... Vacant L.G~J~,...,./~ .................. Location ~f Prnn~v ~ ~_~JC-~ Owner Or-Owner-~-~ ~'~erty"~'""'iii~ .......... i~.."-~iiiiii............................' .................... Subdivision .................. . ..~..........~ ............................... Lot No..V(~.. Block No..% ...... House No.....~......O.. Permit No ........ %~-~.....:/JJJ~/~, ~'.,-. ~/~Date Of, r ~erm,l~ ........... Applicant ..... ~. ................. J~/;";~-~ ............................ Health Dept. Approval ~.~'.....'~.;.~ ............ Labor Dept. Approval ........ .'........~ ............................. r'ter A r I~ Underw t s pp ova .~ ........... Planning Board Approval ..:..... ................................ Request For Temporary Certificate ........................................ Final Certificate .............. .~... ....................... Fee Submitted $ .....~... ............................. Construction on above described building and per, g~ me, ets_g~ applicable codes and regu~t~ons. Applicant ........... /~..~. ~ ...~...~ ..~...~ ......... ~ ......... Sworn to before me fl~s U ~ day of'~ ./.Z :.7...~... (stamp or seal)" PRE C.O. INSPECTION July 6, 1977 260 Clark Road Southold, N.Y. Tax Roll: Mrs. GUS Dellanno At approximately 8:40 A.M., Mrs. Dellanno admitted me to this building. This building was formerly a barn with a concrete floor. It was converted into a one-family dwelling with a kitchen, living room, two bedrooms, and a bath. Outside there is an entrance to the utility room containing the panel box, pump, and gas hot water heater. There is an oil-fed floor furnace in the cellar connected to a masonry block chimney. Outside there is a set of steps to the second floor which is a non-habitable attic. I found the premises and building to comply in general with the Housing Code of the Town of Southold. The inspection was completed at approximately 9:00 A.M. Respectfully submitted, GF:med George Fisher Building Inspector Board of Appeals #2116, April 29, 1976, Margaret Dellanno granted permission to subdivide property.