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FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.......2~00Q$.... Date ......July. 1 19.$O
THIS CERTIFIES that the building .
Location of Property 'IA$0. T.erx}r, L,ane... • . , . • , . , , • , , , , Southoldl N.Y.
House No. Street Hamle[
County Tax Map No. 1000 Section ,6.4 ......Block 3...........Lot .
Subdivision ...............................Filed Map No. ........Lot No. .
requirements for a one family dwelling built prior to
conforms substantially fo the
Certificate of Occupancy
....Apri.7.. 23• • • • • • • • , 19 .57pursuant to which ..........290OA$ .
dated .....July..9 • • • . • ....19$0. ,was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .
............One. Family. Dwelling. with. Olne. C.az' .G~F.age, •(detached)• • .
The certificate is issued to .......JOS.eph. C....~k1C@X'$M .vg~., • . • • • , • . .
(owner,ObC
of the aforesaid building.
Suffolk County Department of Health Approval ..............N/R • , • , , , , • , , , , , , , , , , , , , , , •
UNDERWRITERS CERTIFICATE NO ......................~IR .
Building Inspector
A.. ana
_
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 1080 Terr Lane South d Y
number & street Municipality
Subdivision Map No. Lot(s)
Name of Owner(s) Joseph C. Ekkers & wf.
Occupancy R - 1 owner
type owner-tenant
.Admitted by: Mr. Ekkers Accompanied by: self
Key available Suffolk Co. Tax No. 1000-64-3-12
Source of request James J. Bvrne Date June 9, 1980
DWELLING:
Type of construction Wood #stories One
Foundation cement block Cellar full Crawl space
Total rooms, 1st. F1 5 2nd. F1 3rd. F1
Bathroom(s) 1 Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat gas Warm Air space Hotwater
Fireplace(s) No. Exits Airconditioning
Domestic hotwater yes Type heater gas
Other
ACCESSORY STRUCTURES:
Garage, type const. 1 Car/wood Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Descri tion Art. Sec.
Kitchen Gas stove - no shut-off V 2- 2 E G
Cellar Water in cellar III 52-30 D
Remarks•
Inspected by: Date of Insp. July 1, 1980
Curtis Horton Time start 10:15 end 10:45
' r()~ PUILM NO. U
TOWN OF SOUTHOLD
• i Building Deportment
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 Bon rd 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 $1.00
Dote ........Iune...4,...19.$A............
New Building Addition Old or Pre-existing Building .....x........ Vacant Lond
Location Of Property S.R.:...SQ.11*.klht~S.~...4.f„Hobart„Roads„n,Qrthwest„side„of;,Terry.,Lane
Suzanne, Jane Ann and Thomas J. Ekkers and Elizabeth
Owner Or Owners Of Property ...Fi....kIGAGJ:AIA.kz
Subdivision .....................................................Lot No............. Block No............. House No.............
Permit No Date Of Permit ....................Applicant ...........QS?n~1:$.........................................
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning Board Approval
Request For Temporary Certificate Final Certificate ...........JLJC..........................
Fee Submitted $ .~...QA
Construction on above described building an i t meets a app 'b~lj~~_c~odes and regulations.
Applicant ...............LS~~~~:!;v„~;!;1..:....................................
~`homas~~J. E ers
Sworn to before me this
-NI ~ d. Z /ooo ~
may of .............Janar....1980...... ~ (stamp or seal) 7~/tea
Notary Public............Suffolk County -
JAMES J. BY / /Ce
Notary Public State New Ton y
No.52S560 i
Q„al;sea m su~vr er J
Comm. Expires March 30. 1