HomeMy WebLinkAboutZ-9580 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DErARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No . Date ................................,19...
THIS CERTIFIES that t1t~~ujWina • • • • NI'G"~b A ~ ' ~ ' ' • ' • ~ • • ~ ~ • ~ ~ •
FacaUon of ProDaat~i Howl No. " ~ • • • ~ • ~ f r s'vrei . 5 ..............1 . ~ •~Him%I[
County Taz 1[aprJ~ta. lOpO Sectiq~f ............Block ..Lot . .
~P1,1.6 tvrr~ ..'.r. j. .y~i.5 J. J.~
Subdividon . ~k ~+U.~ E rnL. ~i~ ..I~11ed Mpp Nw1: • N~+~~ •fL9~,11tQ4 u, rn • •iSC'rL~• • 1 r.. r
cot~fQrms substa~tba~tt~+ toZ~e tr~p~lication for Buildlt~~I'ermiL baratofora fibd,im,thip office dated
~ L - i~~'. Z95~U
...J 19~ , po't0~'Bs1!estierlt Na. .
dated 19 ~ ,was issued, and conforms to all of the requirements
of the applicable prov of th law. The occupancy or wfitich this certificate is issued is .
f) -f'~~lA~~ ('ilk ~A~' rL'( UIU ~i Lt. ~r~~~
•3
.ALise~t~ .N ...fi...i:i'l.l.iA'ri 'r'r'a,tA.~.~.$.........
' The artiflcateisiauedto
' Conner, Maw or tenenU
of the afoswid buildin3.
-~,~,r' - Ir.x~''.'Irr~G
Srffollt County Dapargnent Ot Health Appro~r~j .
t)NnBRWRITl~ CERTIFI
`C~~'E NO .
/
~i/y ter{ it
Building Inspector
w~+77s
BUILDING DEPARTIfIE1dT
T01~lN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 9 3 ~ ~ o sx'iw..~ Q,r~ °~...?.~G,GvGcu,~
number & stree (Nlunicipali~-
Subdivision~~~~ Map No.,~ •7.S - Lot(s) Sy Ss'S~,
Name of Owner(s) -~d'/,rrQi'.,e~
~
Occupancy /S -
ype owner-tenant.
Admitted by:~!'fx Accompanied by:~~
-a'a•Z
Key available ~ Suffolk Co. Tax No. 3-- d~~~
Source of request ~~G,.f~ic..zi- Date- ~l /
DWELLINGi
.Type of construction stories p~~
" Foundation ~,,.1,.,,a` Ce11ar,Crawl space
Total rooms, 1st. Fl 2nd.. F1 3rd. F1
Bathroom(s)- Toilet room(s)- y'>+•~ .
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat~~7~,~, ' alarm Air Hotwater •
. Fireplace(s)•Q,,,Q No. Exits Airconditioning
Domestic hotwater Type heater
~ Other
ACCESSORY STRUCTURES:
Garage, type const. f.~, ....2.~-rf~ Storage, type corist. ~,2`~.
Swimming pool Guest, type const.
Other ~i~sGr
T
VIOLATIONS: Housing Code, Chapter 52
Location Descri tion Art. Sec.
I
Remarks•
Inspected by: ~ ,w /¢lr~~ Date of Insp.
- ...Time start/v. 3U end ; a~
FORMpW.i n ~ 2
TOMVN OF SOUTHOLO U 1.=,
~T~oNmt ~ 2
Sostd~old,N.Y.11571 ~ i+~~
' APPLICATION FOA CERTIFICATE OF OCCUPANCY T pF'so"'-
oL .J~/~
A. This application must bt filled in typewrftiar OA ink, and rsbmitted in duplicate t4 the BuNding lnspeo-
mr with the following; for new buikfits~t or neaw uer:
1. Final survey of property with arx~uta location of tai quildirgµ Property ling, atreats, and unusual
natural ~ topographic featunss.
2. Final approval of Health DePt• of atafer supply and faMKerapa dilpogl'-~S'9 fA?m or dgH#U.
3. Approval of elecVical installation from Board of Firs UndertiwrlfAts.
4. Commercial buildings, IndusuW lwildGtgd, lAultiPla Aaidsetica srd similar buiklingt and installa-
tions, a certificau of Code compliance from dte A~hitaat or inngir?eer nsapos>~bMe for the 6t?iidinp.
5. Suiamit Planning Board approval of aontPktad life plant nicWlrren*ttta where appUable.
B. For existing buildings (pr'xN to April.. t>i6y?, Non-conforming uaea, err buiklinpt and °paaxiairg"
land uses .
t. Acwrate su?veY of property akwwirq aU propsrtY lino, atraets, buildings and unusua natugl or
topographic features.
2. Swom statement of owner or previous owner as to ua, occupancy end condituan of buidings.
3. Dam of any housing coda at safety kaprction of f~iidings or praimisee, or otMr psvtineM informa-
lion required to prepare a artificata. '
C. Fees: ,
1. Grtificaa of occupancy 56.110
2. Certificate of oixuPancY on pre~ciatktg dwelling or land µsr 56.00
3. Copy of certificate of occupancy St:lI0
Data
New Building .............Ofd or Pnwtist~in_g` 8uildir~X) . Nacant Land
Location of Property .2?3,~z......,..... Mme: ?9v~ . ~ v~ • ~ :~.5'`~~ .
Hour Na Suaat ~ Naabt
Owner or Owners of Property ~C
.~n~ ~Ye 5 ~Go~V ~ .......I .
County Tax Map No. 1000 Section ~ Block Lot . ! . .
Subdivision .................................Filed Map No. ..........lot No. .
Permit No........... Date of Permit ..........Appl'u~ant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval •
Request for Temporary Certificate ....:................Final Certificate
Fee Submitted S . , .
..~i.. ,
Construction on above described building and permiilmaets all appi(Fabll~' ode;and regulations.
Applicant . , ~ C Yl id°ti-1`...... .
a«.tatoaa ~ '
.