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FORM NO. 4
TOWN OF SOUThIOLD
Bt1ILDING DEPARTMENT
Town Clerk's Office
S~thold, N.Y.
Certif icafe Of Occupancy
7101'75 - October 2 80
No..: Date ..............'..........'.......,19...
THIS CERTIFIES that the building .
Location of Property , 305..M1J-i..Craeas .Dri~ze . ~
quthoa,d........... .
House Nc: Strost Hamlet
County Tax Map No. I000 Section 35:.:....Block ~ ..........Lot . 28 .
Subdivision .................:...Filed Map No. -.-.....:Lot No. .
requirements for cone-Family dwelling built prior to
conforms substantially to the A¢~7t~Atf'dh: fd3'8'u'~?dTn~'Pe'rmit~erefiofoie 'fil'e3 in`4us office ilafed-
April ~ Certificate of Occupancy
....:.....::3 , 19 5.7. pursuant to which'$m'idingYeimif No--.:..........210175.. .
dated .October. 2., ................19 8Q ,was issued,. and conforms to all ofthe requirements
Private
of the applicable provisions pf thelaw. The occupancy for which this certificate is issued is , . ,
Onc-Family Dwelling .with update o~ Pcrmit #631?Z - C0 #25428 - 9/2/73
Albert.ESkins~92/29?7?)
The certificate is rued to ,
fowmei,
of the afgrasaid building:
Suffolk Couttty Department of Flealth Approval
UNDERWIt~IT$RS CERTIFICATE NIO... , .
Building Inspector
Rw 4l19
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 0 Mil Southold
number & street Municipality
Subdivision Map No. Lot(s)
Name of Owner(s) Albert D. Eskin
Occupancy R-1
type owner-tenant
Admitted by: MrT Accompanied by: Mr F.clrin
Key available Suffolk Co. Tax No.~35-3-27,28
Source of request Albert Eskin Date Oct. 1, 1980
DWELLING:
Type of construction Wood #stories One
Foundation Cement Block Cellar PartialCrawl space Rest
Total rooms, 1st. F1 2 2nd. Fl 3rd. F1
Bathroom(s) Toilet room(s)
Porch, type Deck, type Patio, type Cement
Breezeway Garage Utility room
Type Heat Oil Fired '+7arm Air g Hotwater
Fireplace(s) _ No. Exits 2 Airconditioning -
Domestic hotwater Yes Type heater Electric
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.small metal
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Descri tion Art. Sec.
No violations of the H s'
found.
Small addition with bathroom Permit No. 631'7Z was issued Dec. 29, 1972-
Remarks: C. of 0 issued Sew. 7, l q'z,•3 _ ~ G5 ~R
Inspected by• Curtis Horton Date of Insp. Oct. 2, 1980
Time start 11:30 end 12:15
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-(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 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 Cl! /..9~.~.......... .
New Building .............Old or Pre-e~xjisting Building" .~.0? Vacant Land .
Location of Property ..~~~.~.......l/!.Zl.~~;~z-~C-.~~..~~1 , , , , , ,
House No. G/t~~.... L~~<~~ .............Hamlet
Owner or Owners of Property , , , , , , , , , , , ,
County Tax Map No. 1000 Section Block Lot . ~ °?~I... .
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 X................. .
d G j"
Fee Submitted $ ~ ~"f J
Construction on above described building and er ~eets all ppli le co es and regulations.
Applicant F!~'..~"`-`-~..................... .
Rev. 10-10.78 ~
~ ~~~~?,,U ~~"15
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