HomeMy WebLinkAboutZ-10828 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. 210828...... Date .....December 2.2 19 .$7
THIS CERTIFIES that tlte,building s .
Location of Property .9355 P1a~c~..t•(R~ri..(.S , it....25
~aaG. i~ar.lon
House No. Street Hamlet
County Tax M1lap No. 1000 Section ..031.......Block ...03..........Lot ..0 J 7........... .
Subdivision X ..........Filed Map No. .X ......Lot No. . X........ .
Requirements. for a private one-Pamily dwelling built prior
conforms substantially to the A~ieatioe-for-B~uilding-Pernik-heretofete•fikd-in-titis-offiee~dateck~
Certificate of Occupancy
to, April, ,23 , , , , , , , . , 19 57 pursuant to which-Building~PemrirNo. .........2,1,0828, , , , ,
dated ue,cember , $2, , , . , , , , , , 19 &.I. ,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 Q..... .
prigate..one-fanil.y ,dwelling-, ,with, ,Yiir~, .accessory structures.+~
The certificate is issued to 1?a.taL€..Qf . Alldrgw, J , , Dzenkowski
(ownerj~gE ert9narttl
of the aforesaid building.
Suffolk County Department of Health Approval ........N /R . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO ................N /R, , , . , , , , , , , . , _ _ .
+~1. wooden storage bldg.
2, barn
3. pump house
4. L car wooden bldg.
5. large wooden storage [
Building Inspector
Aar. vat
HUILDIhG DEPI!RTi~1ENT
TOi•.74 OF 50UTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 355 Main Road Route 25 East Marion
number ~ street) Municipality
Subdivision x Map No• x Lot(s) x
Name of 0•.m er(s) Estate of Andrew J. Dzenkowski
Occupancy R-1 unoccupied
type ( owner-tenai,t
,Admitted by; Mr, Dzenkowski Accompanied by: same
Key available Suffolk Co. Tax TJo.o31-o3-ot1
Source Of request R.G. Terry, Jr.; atty. Date 12/14/81
DI'~,LIt~G
Type of construction wood framed #stories 2
Foundation poured cement Cellar full Crawl space
Tctal rooms, 1st. Fl 5 2nd. F1 4 3rd. F1
Eathro~:~(s) 1 Toilet room(s)
Porch, type Massed in Deck, type Patio, type
~~~~~~m~ay pantry Garage Utility room x
4`ype Y.eat oil fired 'rlarm Air Hotwater x
Fireplace(s) No. Exits 2 Airconditioning
Domestic hott•~ater Yes Type heater tankless
Other finished room in cellar, stairs leading to large attic
ACCESSORY STRUCTURES: 5
• Garage, type const.` Storage, type const,l__wood,
Swimming pool Guest, type const.
Other 2-barn, 3-pump house,4--2 car wood storage bldg. 5--large wooden
storage bldg.
VIOLATIO^IS: Housing Code, Chapter 52
Loca~ion Descriotio_r, Art. Sec.
kitchen. as stove--no shut off V 2-52-2
outside rear ste s--bad III 52-30-A
outside needs ainting badly III 52-31-B
utilit rm. ceil'n down IIl 52-32-C
stora e bld ~5 is in very bad shape III 52-30-A
7 2 3 4 all need major repairs IIT 52-30-C
Remarks• ~j
Inspected by: ~icn.~ ~~t~;('r1 Date of• Insp. 12/22/81
Curtis W. Horton Time si,art 9:05 end 9:35
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 In~ec-
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 19571, 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
topographicfeatures.
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 onpre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00 ~jjp,~~
Date w`"`~...! ~J.
New Building . . . ..Old orPre-existing Building ~ Vacant Land .
Location of Property ...........r !!"~-Y. r-....~. y`~.~ • • • • • • •
House No. / Sireet/~~/` L ~ Hamlet
Owner or Owners of Property . t"""' _.1 ~"'C?~d .
County Tax Map No. 1A00 Section . Block 3 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 a~ permit meets all applicable codes and regulations.
Applicant .~'°`xt`~w /C/J//~/.(N'.. .
Rw. 10-10-78 ~"~J ~-u"~-.A~/ ~
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