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Home My WebLink AboutZ-11904FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.~!~P. qq .......... Date ........ {~P~F..7 ............. 19~. THIS CERTIFIES that the building .s...( .2. ) .......................................... Location of Property . .5.8.2..7.5 .................. .~.a.~..n. ?.o.a..d ............&o.u.t~b9.1.d. ..... House No. Street Hamlet County Tax Map No. 1000 Section . . .0.~ 5 ...... Block . . .0.6 ........... Lot .. 9.3.3. ...2 ......... Subdivision .... X. .......................... Filed Map No..X ....... Lot No..X. ........... Requirements for a private one-family dwelling built prior to conforms suostantlally to the Applw~at-ion- f~r-Buil~~}texc~tofrrr~ -fried- tlr tlds- Offi'~'~ Certificate of Occupancy ·...Ap.r.i..1..2.3. ........ ,19 .5.7. pursuant to which Baildheg-PermR No...Z. 1 .1 9.0.~ ............ dated ..... .S.e.p..t ?.m.b.e.r...7 .......... 19.8.3., 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 ......... ... ~..~r ~y.~t.e...o.n.q ~ .r.a.mA ~. 7..dy.e..1.1.i.u ~., .a.nfi...a F.c.e.s..s .o.r.y' , .~.a.r.n......* ............... The certificate is issued to .H.O.W..A.R.D..W.:..D.I.L..L.I.N. qH..g.H...~. ?....&...H.I.S. ?..I.F.E ......... (owner, of the aforesaid building. Suffolk County Department of Health Approval ..... .n p..r.e..c 9.r.d. .......................... UNDERWRITERS CERTIFICATE NO ............. ¢ 9..r.~ 9 p.r.d. .......................... *The accessory shed is to be torn down. Building Inspector Rev. 1/81 BUILDING DEPAR~ TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location 3--~ ~ ~ ~ ~'}~,J~ ~/ ~~F~ (number & street) (Municipality) Subdivision Map No. Lot (s) Occupancy ~type) n ~: ./ (o~~8nt) i~itted by: ~ ~~~ iccomp~ied by: ~~ Key available Suffolk Co. T~ No. ~-- ~ Source of request ~~~~~ Total rooms, Sst. F1 Bathroom(s) Porch, type Breezeway DWELLING: Type of construction ~~ #stories Foundation z~ ~ ~-~Cel~ar~ Crawl space~ Toilet room~) Deck, type 3~?f Patio, type.__ Garage Utility room Type Heat ~ Warm Air , Heewe~rsr Fireplace(s) .No. Exits ~ Airconditioning~ Domestic hotwater ~/~ Type heater ACCESSORY STRUCTURES: ~/ Garage, type const. Swimming pool Other Storage, type const.~/_~ Guest, type const. VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. -- - . Remarks Inspected by: Date of Insp. Ti~e start/> .~end 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 usa: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal--iS-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. 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 unusual natural or topographic featu res. 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 $5.00 5-/$ 2. Certificate of occupancy on pre-existing dwelling ~ land usa ,~/ 5.00 3. Copy of certificate of occupancy $1.00 Date. · · · .~.~, $/,~._~ ........ New Building ............. Old or Pre-existing Building . .~.. ....... Vacant Land ............. Location of Property . .~..~...~..~.~4 .~..~-. ...... .~. ?i'.0..A.. ,~....~ .~./~r.~. ...... .~.~.~...~...~./.d .... House No. __ , Stoat Ham/et Owner or Owners of Property ~.~..f~. ~/.~, ~....~).:..~..//~.~..~.7~-..~......~"..~..' ................. County Tax Map No. 1000 Section ...~..~..~.C ...... Block....~...~. ....... Lot .... .~..~,~. ...... 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 Tempora Certificate ..................... Final Certificate ~ Fee Submitted $ ...... /. ~ ~....~...~ ......... Construction on above described building and permit meets all aDDlicable codes and regulations. /~. ~- ~. ~"-0~) Applicant ~~. ~. ,.~..~., ....... CONSENT TO INSPECTION do(es) hereby state: · the undersigned, That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at o · which is sho~-n and designated on the Suffolk County tax map as District 1000· Section~, Block_~_, Lot _~_~. That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances· rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated:~ (signature) (print name) 77- 5 -75'7~5'