HomeMy WebLinkAboutZ-9574FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.. Y. 957.4. ......... Date ................ ~uae~ .27 · ....... 197. ~.
THIS CERTIFIES that the building ................................................
Location of Property . .415.0.5 ...... COlaltt;y. Raad. ZT~tr~tOnt;hOla, ...................
House No. Hem/et
County Tax Map Ho. 1000 Section ...059 ...... Block .... 03 ......... Lot...0.2..0 ...........
Subdivision .......... XXX. ................. Fried Map No .... ~t"zX..Lot No .... XXX ......
RI~UIRF~ENTS FOR A ONll F~LI:LY D~J2bZNG BUZLT PRIOR TO
conforms substantially to the -- ' '
· ^ CE RTl FI CAT. F,_J2F_~CY Z9574
....... Apr;L.l -23., .... , l~ ~$ pursuant w wmcn IIl~lamlaxlm~ z~o ......................
dated .......... Jlane. 2.7., ........ 19 ?9., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for wh/ch this certificate is issued is .........
The certificate is issued to .... M..ay..S. ~. p.o.n.a..hp.e. ......................................
(owner, I~
of the aforesaid building.
Suffolk County Department of Health Approval ..... I~IK~.-.I~Ii~EIS.~II~IG .......................
UNDERWRITERS CERTIFICATE NO ............. PR~-.EICIIg.'IIItt(I ..... .../ ............
Rev 4H9
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
Location
Subdivision
HOUSING CODE INSPECTION REPORT
(number & street) (Municipalmty)
Map No. Lot(s)
Key available
Suffolk Co. Tax No.~-~d
Source of request
DWELLING:
Type of construction
Foundation.
Total rooms, let. F1
Bathroom~
Porch, type
B~eezeway -~--
Date
#stories ~-~
Crawl space~z~2
3rd. F1
Toilet room(s)
Deck, type ~ Patio, type
Garage ~ Utility roomT~/eg~/'
· Hotwater~_~__.--
Type Heat~warmAir
Fireplace(s)~ No. Exits ~0 Airconditioning---'
Domestic hotwater,~//~fz~ T~e heater ~.~
Other /
ACCESSORY STRUCTURES: ·
Garage, type const.~Storage, type const.. ~"
Swimming pool ~ Guest, type const. ~
Other
VIOLATIONS: Housing Code, Chapter 52
· ,,L~cation DescriPtion Art., Sec.
Remarks: ~ , //
Inspected by:, ~~~~Date of Insp.
Time start-g;~end .~:~/~'~ '
I~OBM NO, 6
TOWN, OF SOUTHOLD
, Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OGCUPANC:Y
Instructions
nsiS application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building
pector 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.
Submit Planning Board approval of completed site plan requirements where applicable.
r existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
nd uses:
]. Accurate survey.of property showing oil property lines, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings.
3'. Date of any hous~ing 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 / /
I I,~.~1~ ~
Date
/-
New BU' d'ng ................ Ad~litic)n ................ Old or Pr~,~xisting Building .,~ ............ ' Vacaj~ Land ..............
Of Property ...~../....~./.~.....~...~......~...~...~C,.../~......~.....~.~~.J~-~' /- *'' ' '~ ~ / ~ "-'~~.. __ .....~ .~.....-/-....-..-
Location
Owner Or Owners Of Property .~/../.~.~,~...~....:................................... ..................................................
Subdivision ................................................................ Lot No. ............ Block No ............. House No .............
Permit No ..................... Date Of Permit .................... Applicant ..................................................................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ FinaJ Certificate ..........................................
Fee Submitted $ ...~.........~... .................
Construction on above described building and peri~1't meets ~i/ (/G~/~.. a_r~ulations.
Sworn to before ~,~s_ ~, .~ ? / ' ,. .,~
· .~...~.... d~y oI~, .~ ~.]./~,/..i,~...~.....
~ Publ'c ....~County