HomeMy WebLinkAboutZ-9619 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No... ~9~99......... Date August..7 19.'79
THIS CERTIFIES that the building .
Location of Property ....490. Tray. Ave. Matti:tuppk . N.Y.
House No. Street Harr~ler
County Tax Map No. 1000 Section ....1.43.....Block 03...........Lot OA9
Subdivision XX ........................Filed Map No. . X......Lot No. . X .
R.h~lU79~S FOR AM LY DWI~~.LI U T IO 0
conforms substantially to the 7F it7f
~ ~ ~ ~occUpArlcY
.......April. ?_3 , 19 . ~7pursuant tow c Z96a g... • • . .
dated .....D.ugust• 7• • • • • • • • • • • • • ~ 19 .'7G, 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 .
...Private. one . family.:dwelling. with. an .accessory..structtxre .
The certificate is issued to ......Karen .C.. P...Eckert .
(owner~~l
of the aforesaid building.
Suffolk County Department of Health Approval 1`;/.R .
UNDERWRITERS CERTIFICATE NO........... N/k .
Building Inspector
R.v 4/79
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-IS-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 ~ .
New Building ...........+try.' Old or Pre-e ' ing Buildi g ~ .MVacant Land '..1.'......... .
Location of Property ~ . ~ '~U!~'~'!...... .
Houae No. v rt _ . _ ~ ~ ~ / Ham t
Owner or Owners of Property ,!'^~"v.~.J.v'/~~., .
County Tax Map No. 1000 Section ~.~,,;,1 Block . ~ Lot ..'Q 4.q....... .
Subdivision .................................Filed Map No. ..........Lot No. .
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Plann' Board Approval .
Request for Temporary CerlifjFate .....................Fi al Certificate . .
Fee Submitted $ ~
Construction on above described building and per i e a a icable co an egulations.
Applicant.
Rev. 10-10-75 C .O . ~
x/7/79
hec ~ llnc~t~1
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location /SA~f /~l,~JT/iTiC~-~
y,
number street Municipality
Subdivision Map No. Lot(s)
Name of Owner(s) fci4lzcn< ~ f"<'~c/~
Occupancy / ~OGf C_~L.42/~
type ~o~a--tenant
Admitted by: ?Ubl/ C~A/Z~ Accompanied by: J~ ~,q~E ~ ~ ~oa~v,o~
Key available Suffolk Co. Tax No.r/,[~j -/<~.3-~3-0~~
Source of request~~~ Date ~d'-
DWELLING: ~~°o~/
Type of construction GVO00 ~~A~-!r ~_#stories / ~ z,
Foundation (.C/tsCwT,CzLoc.~ Cellar~~~L Crawl space -
Total rooms, 1st. F1 - 2nd. Fl u p~S 3rd. F1
Bathroom(s) ~ Toilet room(s)
Porch, type
f_~,c2~,~Deck, type Patio, type
Breezeway Garage Utility room_
Type Heatm~~ ~%/ZcA Warm AirL~ocTLgS~ Hotwater
Fireplace(s) No. Faits /H/~c Airconditioning
Domestic hotwater ~€5 Type heater
~,.~QS ~,~",O
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.~,~~ ~ja~
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Descri tion Art. Sec.
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Remarks: ~ - /iGc .,Glss<l,oQ.Cc ,OS G/
Inspected by: Date of Insp. - 7 /
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