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HomeMy WebLinkAboutZ-7104 FOSM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'e Office Southold, N. Y. Certificate Of Occupancy No. ~7104....... Date JulY.... ~ , 19. ~6 THIS CERTIFIES that the building located at N/S .North . (toad . { CR2~). Street Map No. Block No.. xx ......Lot No: XXac...$Qtxtr.4ld.. fi .y . r© uiremens F o e fa it we i & h~~~g code conforms substantially to the CXX built ffe~t~fig,ate,_Q~ occu cy dated be.fora..Apx'...23.., 19..5? pursuant to which o. Z..p~jp~' dated ........July 1 19 . ~6. , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Private one family dwelling The certificate is issued to . ?hilip. _Fagarsham _ Own@F, off, Fee4f~, , . , , , , , , , (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval P.re- existing UNDERWRITERS CERTIFICATE No. ...Pre- existing HOUSE NUMBER ~`~~~5 Street North Road (CR27)_ . Southold. ;f;FT), Building Inspector HOUSING CODE INSPECTION July 1, 1976 54005 C.R. 27 R-1 Southold, N.Y. Tax Roll: Philip N. Faversham Occupied: Owner Upon receipt of an application for a Pre-Existing Certificate of Occupancy, I made an inspection of this one-story framed dwelling. I was admitted to building by Mrs. Faversham and began inspection at approximately 2:55 P.M. The building consists of three bedrooms, kitchen, living room and full bathroom. Heat is furnished to building from a gas fired, warm air furnace located in full cellar of building, poured concrete foundation with heat outlet in living room floor approximately centered in building. I found no violations of the Housing Code, Chapter 52, Town of Southold, N. Y. Inspection completed at appro~mately 3:15 P.M. Res ectfull submitted, ~ G~~~~.- ward Hindermann Building Inspector EH:med FORM NO. 6 TOWN OF SOUTNOLD Building Department Town Clerks Office Southold, N. Y. 11977 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 Board 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 opproval 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 certifica}e of occupancy $1.00 _ Date \..?v~~.../../..1..~~..'.7~~... New Building Addition ~Id or Pre-existing Building Vacant Land ~ . Location Of Property .lt!~~ )~~1.Tf.,ICI. ~..~.(.~.'y.,.............. ..4 / Owner Or Owners Of Property ~,~~/~~.......7.1:~ ~/.s.... Subdivision - ~ ...............................Lot No............. Block No............. House No.~5.~4U J'- Permit No.........~'..... Dote Of Permit ....................Applicant Health Dept. Approval ........~'?.,1~= .....................Labor Dept. Approval Underwriters Approval ...........F`:../...1~.. .................Planning Board Approval ....~~~~L Request For Temporary Certificate Final Certificate . r Fee Submitted $ .~.1 Construction on above described building and p rmit meets all op licable codes and regulations. Applicant X...~ Swam to before m t is /~j 7~ I ~ day of .D(..d (stamp r D ~7(®/ Notary Public County ~ ( + Sa l3~'~r / , , ~ . ~i~J~{c~e '1f~ ,r{~~f~~j• r ` r3 r~! S rh'i•1'7' " "~i`~Y~~'.,'~'S J~r' 4~.~1~~~ .Nn°'•., W.~'. r f ( ti tS4 .j,1 w 1~y4 iy' S ~r ~ r ~ y~~~ t~r~ i` ~~5 .~~~k~ l~ t. N Tf~~ /tl ~s.r'• 'S•° f illvt'1 /S"' f~ .r r :`,-,J [ r. ~ ~ b 1. "Z A J l 11-4'f~' r H ~ ~v it r'. t,~'Y~*z /SL.ANO~ SOUND; ~r •2. r: d _ a ~ ~i N O ? ~ 3/ • /9 r /O ,E P _ 1 [ 0 - - ~ ~ O p ~ ~ ~ j ~ h ~ ~ k - ~ - - o .o v ' i• 0 0 - ~ ~ p eiy. t.. 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