HomeMy WebLinkAboutZ-6861 FORM NO. 4
TOWN OF SOUTHOLD
BUlLD1NG DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
Aril S
No. ~,$ba...... Date , 19. ~.b
THIS CERTIFIES that the building located at North lhokvood • give ~ • Street
Map No. Laurel PJt .Block No........... Lot No. pt .L?~..... Laiir~sl...N.k........ .
conforms substantially to the ~y,~~~~~ code
b~•~td .batare.~ r. a^ ~5~!~k'~yot` oac~?anar
a e p ~ 19.57. pursuant to which o...~6~~
dated JSII.. 20....., 19.76., 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 Pria?ats. oa~e . tamily..dweTling ..with. additioa .
The certificate is issued to .Jt~ek ~?ri9COl3• ~ ~ ~ ~ t++3tser ~ ~ ~ • • ~ ~ ~ • • • • •
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .N
UNDERWRITERS CERTIFICATE No. .pre-..axis:.tiag
HOUSE NUMBER ~ 3pp Street . Plortl3 CakwOOd • vrSw ~ ~ • • • • • • • • ~ • • • • • •
.Shia ~ClO. •inelia3es~ ~ork• Hone. auuie,r• .pertrd.t.fP7.109Zr •3!7!?1+~........... .
f
Building Inspecto~
HOUSING CODE INSPECTION
January 19, 1976
1300 No. Oakwood Drive
R-1
Laurel, New York
Subdivision: Laurel Park #212 Lot 47
Tax Roll: Jack Driscoll & Wf
Occupied, owner
Upon request of Jack Driscoll for a Pre-Existing Certificate
of Occupancy, I made an inspection of this one story framed
dwelling. I was admitted to building by Mr. Driscoll who
accompanied me during the inspection which began at approxi-
mately 2:45 P.M.
The building consists of two bedrooms, living room,
kitchen, full bathroom, laundry room with toilet and lavatory,
and enclosed porch. Heat is furnished to all rooms from an oil
fired hot water furnace located in full cellar. Full cellar
is part of the pre-existing portion of building's foundation.
An addition was made under Building Permit #71092 dated March
7, 1974, for laundry room and enlargement o£ living room.
Foundation of this addition is cement block with a crawl space.
Certificate of Occupancy has not been applied for to date for
this addition.
I found no violation of The Housing Code, Chapter 52,
Town of Southold, N. Y. in this pre-existing section of
dwelling.
Inspection completed at approximately 3:05 P.M.
Re ctfully subm}tted,
EH:mm dward Hindermann
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
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
Inspector 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.
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.
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
Dote J.~?~~1r.Y....29.r...~:92.6.........
New Building Addition . Old or Pre-existing Building Vacant Land
Location Of Property ..kT~.S..~IOI'.~Y7...QakkCQO.d..A.>;3.Ye........Laux~l.t...PJ.w..Y.
Owner Or Owners Of Property ...Jack DriSC011 Bc, WY.
Subdivision ..~r~.~,?rel„Pg,;'~,,,,,LOtr,,,gft.of„ZF']„Lot No Block No............. House No..~.34Q..
197+
Permit No...7~~~Z..... Date Of Permit ..M..24x'r...7a..Applicant .Jack„DriSC011
Health Dept. Approval ........~tjfR ............................Labor Dept. Approval .......IQ/.~i.................................
Underwriters Approval ...........................................Planning Board Approval ....I1T./.~............................
Request For Temporary Certificate Final Certificate
Fee Submitted $
Construction on above described building and permit meets II applicable odes and regulations.
PP , -t
A licant ~
p
Sworn trodbefore me this _'~//76
a ..~...7. h... (stamp or seol)7/,/~~6~~I
day of
Notary Public County
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