HomeMy WebLinkAboutZ-4560FOBM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupancy
No..~..~.~.0. ..... Date ........... .F.e.l~ ...... ~ ...... , 19..?~..
THIS CERTIFIES that the building located at . .~/'~..Hummel .AYE ......... Street
Map No.. ~ ........ Block No... ~:~ ...... Lot No. ~ .... Seuthold. · .N ,]/., ........
conforms substantially to the ' ' g
~'l~tl~' l~*lor' ' 'lV~'~J. 19.57. pursuant to which ll~i~j~k~..~/0 .~60
dated ... 1~®]~ ..... ~ .......... , 19.72, 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 ... g~.~v,'~;a, or~e .£a~;51y. ¥.wel.~ Ir~.g ....................................
The certificate is issued to . .Frallcez..])~o.~ey ..... ~;r,et~ ...........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .. P~ .~l~.~;ll'l~ ..................
.....
Building Inspector
HOUSING CODE INSPECTION
January 31, 1972
Owner - -
F. Barszczewski
185 Hummel Avenue
Southold, New York
(Mrs. Dooley)
Our office asked me to make this inspection.
About 3:15 P.M., Mrs. Grattan, occupant, admitted me to
make the inspection.
I found the house, a one family dwelling,
conditionS. There were no violations. There
garage in the rear yard.
in good
is a detached
GHF:BN
Respectfully submitted,
George H. Fisher
Building Inspector
* Floor plan sketch contained in file.
FORM NO. 6
TOWN OF SOUTHOLD
Building DepOrtment
Town Clerk~ Office
Southold, N. Y. 11971
APPLICATION 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:
]. 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.
New Building ............... /... Old or Pre-existing Building .......... : Vacant Land ............................
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 ........................................
Temporary Certificate ........................................ Final Certificate ....... ~. ............................
Request
For
Fee Submitted $ .~..~.....~... .....................
Construction on above described building and permit meets all op_plicable codes and regulations.
Sworn to before me this
.... ~ day of .~/..../..~..~ ~ (stamp or seal)
....... ~.... Coun~
Nota~
Public
No, 52-812585D, Suffolk Co~y~y
Term Exp es M~rch 30, 19'~>