HomeMy WebLinkAboutZ-11210 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
' Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. 2.1.1210.......... Date . ,September 21 19 ,82
THIS CERTIFIES that the building .
Location of Property ..22325 MH.1A .Road , , , , , , , , , , , , , , ,Orient . .
House No. Street Hamlet
County Tax Map No. 1000 Section ..01 S.......Block ...01..........Lot b.......... .
Subdivision ...X ...........................Filed Map No. .x ......Lot No. . X........ .
Requirements for a private one-family dwelling built ppior to~
conforms substantially to the A1~plieatiex+-fer~Bail~irg-Pernrit-heretofore-filed'ia'tttis'tlftlLZrdated-
Certificate of Occupancy
A.Rr, il. 23 , 19 T pursuant to which BWildirrg~Pennit•No. Z t.12 7 D........... .
dated SQp tea~ger, 21 , , , , , , , , . 19 ,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 .primate..oue:-.farptl~.Y.. dwe111n8.• .
The certificate is issued to Anas ts~alr~. Duvall _ , , , , , ,
/owner, lessea•er~terasntl-
of the aforesaid building.
Suffolk County Department of Health Approval .......r}(a .
UNDERWRITERS CERTIFICATE NO ...............n~a............................... .
i
;'1
Vic(-Q!dut!
u' ding Inspector
Rw. 1/87
' , FOEM NO. 8
TOWN OF SOUTHOLD
Building Department
Town Clerks Offiee
Southold, N. Y. 11971
i 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, anti
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 Hoard 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 $1.00
Date ..9.~$~82
New Building Addition Old or Pre-existing Building Yacant Land ,
°~~Main Road, Orient, New York
Location Of Property
Anastasia Duvall
Owner Or Owners Of Property g. .l. .1.~......
Subdivision ................................................................Lot No. 16........ Block No..1......... House No.............
Permit No Date Of Permit ....................Applicont
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning 6oord Approval
Request For Temporary Certificate Final Certificate
Fee Submitted $ ..,5: 00
Construction on above described building and permit meets /~/pplicable~o r/egulations.
Applicant .........................Z~!~yC~T.7~'.1.....~.vw_~fl~i?~?•.......................~
Swor~ before me is /~i _LO o~~~
day of . ...........................,f...(.~ a (stomp or seal) ~
Notary Public ..5:~!:5~.... County ANN M. ABATE ~
%,f ~ ,-(/~Q~ ~ NOTARY PUBLIC, State of New YorX ~(\y`
~ ~i~~.~/'~" SuNolACounSyNo.4748183 V ~
X~~ Term EeOires M1iarcli 3C, 19.$3
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE/~ INSPECTION REPORT
Location ~o(.j.~~ /~-/~7i~~ ~"~ra~n' (c ~/F,~~' ~ d~ y
number & street Municipality
Subdivision Map No. - Lot(s) -
Name of Owner(s) ~/Hd ~ fo-~,~/~ ~j _ _/~yva
.
Occupancy /C- / ~j~ f
type owner-tenant
Admitted by: x~,~ Accompanied by:
/G~d~
Key available c~p~i-1 Suffolk Co. Tax No. o/~ o/- p,,~
Source of request_~~~ %95iEF~ Date ~'-,Q-~~
DWELLING: /
Type of construction l.(.tonc~-<G~iKE -cy '/I~ Ski„~~~#stories p~ E
Foundation CFA . Cellar-~~if~wl space
Total rooms, 1st. Fl 2nd. F1 ~ 3rd. Fl -
Bathroom(s) ~E Toilet room(s) -
Porch, type - Deck, type Patio, type
Breezeway - Garage Utility room -
Type Heat ~'c,-,7r~ / alarm Air ps/ ,~r<d Hotwater
Fireplace(s). No. Exits ~,,.~d Airconditio/ning -
Domestic hotwater y'E".5 Type heater y~c5'.5 ~/i-~~
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
u u'~ GF i c~ ~a -
o ~ ~ c Tvo ~ ice/ ~5"oa-3Z
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Remarks•
Inspected by• ~ f Hate of Insp. c;ll
Time start3'Zo~lLlend ~ O •