HomeMy WebLinkAboutZ-10320 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.. 21 X320 Date ..December, 23 19 . $Q
THIS CERTIFIES that the building .
Location of Property ..1120 . . . . . . BroaQt+Bte{~p, ,}igad... , , , , , ,Qµxo,$gg}1e, , .
House No. Street Hamlet
County Tax Map No. 1000 Section ~ 04 ......Block 09..........Lot ..002........... .
Subdivision Nassau ,Pt., Club, ,Prop,., , , , , ,Filed Map No. ~....LOt No. 2.~2 .
REQUIREMENTS FOR A PRIVATE ONE-FAIYIILY DWELLING BUILT PRIOR
conforms substantially to the
CERTI
I~CATE OF OCCUPANCY
TO ,April , 23.. , , , , , 19 .~Z pursuant to which ENO. R3Z0...... .
dated December, 23 , , , , , , . , 19 8Q ,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 .
a private one-family..dwelling
The certificate is issued to . Grace .L.. Drum,. Trustee;. Henry W.. Drum,. Succee~por
(owner, /is~w~fw~~ll
of the aforesaid building. Trustee; sad Grace L. Schanz, Successor Trustee
under Laat Will and Testament of William H. Drum•
Suffolk County Department of Health Approval . .
UNDERWRITERS CERTIFICATE NO......... x~ .
.:.l.l~*!!'.. .
Building Inspector
R.~ ane
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-
torwith 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 installa-
tions, acertificate 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 peoperty 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 informa-
tion 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 $1.00
Date .,December.l7i.1980,,.,,,,
New Building .............Old or Pre-existing Building * ...X....... Vacant Land .
G
Location of Property//yBroadwaters Road, Nassau Point, Cutchogue, NY
House No. Grace L. Drum, Trustee; Hen~yt W. Drum, Successor Trusteeem/and
Owner or Owners of Property Grace L. Schanz,Successor,Trustee,und~r,La$tr,W;lk.a~d.T@Stdment
of'N1iTYiam ,1. Drum
County Tax Map No. 1000 Section .104.00,.,,,_„ Block .09;00,,.,,,,,, Lot.,002;000,,,,,,,
Subdivision .................................Map No. .156.......... Lot No. 252.......... .
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$.,5.,00,,,,,,,,,,,,,,,,,,,,,,,
Construction on above described building and perrp' meets al(a icab codes and re ulations.
W e m is a B ss .C.
Applicant......
by Wi li m 'ckh
Rte,. ,o-,oas ~ a/ a 3 j8o
CP/Le) C'.o. z ioa~o rss~.Qrti°
* Built in 1930's ~ ~ ~SOO~
CI~,E ~ 77'a3
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location //a~0 .~ita~•ocfr~rF/ts . Cc.rcHoquc /l/.~
number'& s/tr~eet•~ Munici ity~-
Subdivision~rr,Q/ice/ /~~~Map No. Lot(s) a~a
Name of Owne"r~(s) L(~%/~j~p o s//T~iA~1 sT
Occupancy /C - / f/~ C,~N j
type n owner-tenant
Admitted by:~C ~ 1U/[/~~t./ Accompanied by: S~fIL~L
Key available Suffolk Co. Tax No. - ® Got
Source of request~f1/~,o,~ L(/iC~L//J~9 f~_Date~~
DWELLING•
Type of construction (,(Ja00 ~/GO/C,t~ #stories O C
Foundation G,r.r ~/n~~ /~i~-~c Cellarl~iz Crawl space ~,o,c%
Total rooms, 1st. F1 S #
Rum 2nd. F1 - 3rd. Fl -
Bathroom(s) ~a L L Toilet room(s)
Porch, type ScK~'~r.E'o Deck, type - Patio, type
Breezeway - Garage - Utility room -
Type Heatf=Loo.C s4yK,u. Warm Air ~,CS Hotwater
Fireplace(s) ~/FS No. Exits TZu d Airconditioning
Domestic hotwater Type heater ~,oS F=/,~?p
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Descri tion Art. Sec.
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Remarks•
Inspected by• Insp.
Time start,/Z:is'P !Z: 3Sl~H'