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Home My WebLink AboutZ-10236FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... Z3.0.256 ....... Date .. N.o.¥0t~l.b.e.r. 5~ .................. 19.80 THIS CERTIFIES that the build~g ................................................ Location of Property .~0~..~Y.~$~. ~.~. ~B~ .~e ..... Qr~.q$~. ~ ....... House No. Steer Ham/et County Tax Map No. 1000 Section .. 0 ~ 7. ...... Block . .Q~ ........... Lot . .~ ~ ~. ~. ~ ~ ..... Subdivision ............................... FQed Map No ......... Lot No .............. ., regu~re~ents ,~or ~ PT~vat~ Oner~em~y ~el~ln~ ~lt confo~s substanti~ly to me ~~~~~~ prior to C~9~. f ~te of Occup~cyz~o~ .... fipEil. ~3. ........... , 19.57p~suant to wmcn~--,~b~* ............. dated . NO~O~..5 ~ .............. 19 ~Q, was issued, and conforms to a~ of the reqmrements of the appficable provisions of the law. ~e occupancy for w~ch tbs ce~ificate ~ issued is ......... ........ Prgeate..One,Eaml1E .~e~ng ....................................... ~e certificate is issued to .... 8~uar~ .DO~ .~.~. ~ ............................. of the aforesaid buildhg. Suffolk County Dep~ment of Heflth Approval .... ~/R .................................. U~ERWRITERS CERTIFICATE NO ..... ~[~. ......................................... *C0~Z~882 issued to John Morris for Accessory Structure(detached Garage). Building Inspector Rev 4/'/9 FORM NO. 6 TOWN OF SOUTHOLD Building Depa, t*~ent 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 usc: 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 scwerage 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 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 uscs, or buildings and "pre-existing" land uscs: 1. Accurate survey of peopert¥ showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to usc, 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...~..O..7'~.4F~..~.~../~..~?.. New Building ............. Old or Pre-existing Building ....1~... ...... Vacant Land ............. House No. Street Ham/et Owner or Owners of Property .... .~..~.4~.~..~.~.~.....~.....-~...~.~..~? .~{/. ............................. County Tax Map No. 1000 Section ....~./~ ........ 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 Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~. ".~..~ ..................... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 BUILDING DEPARTrv~NT T0¥,~; OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location Subdivision Name of 0vmer(s) 0ccu~ancy R-1 (type) Admitted by: Key available Source of request 400 Private road #5 (number & street) Map No. Orient, N.Y. (Municipality) ..Lot(s) Stuart Dorman & Wf. Barbara B. Owner (owner-ten,It) Accompanied by: Suffolk Co. Tax No. 017-04-014 & 011 Dorman Date Oct. 27, 1980 DV~,LING~. Type of construction Wood #s?ories 1 Folmdation Cement Block Cellar Crawl space x Total rooms, 1st. F1 5 2nd. F1 3rd. F1 Bathroom(s) 2 Toilet room(s) Porch, typ~ Deck, type Patio, typ~ Slate Breezeway Garage ~tility room x Type Heat Gas Warm Air X Hotwater Fireplace(s). I No. Exits 2 Airconditioning Domestic hotwater Yes Type heater Gas Other ACCESSORY STRUCTURES:. Earage, type const. Wood-2Car Swimming pool Other Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Kitchen Gas Stove No Short Off V 52-52 B ~ Utili. ty Rcom Gas Heater no Shut off V ;2-52-B-1 No Outside air supply V 52-53-G-1 B/P for 2 Car Garage 5863Z No C of 0 issu.~d 1972 Remarks: Inspected by: Date of Insp. Oct. 30, 1980 .. Curtis Horton T~me start 11:15 end 11:40 ,,..,. 'i