HomeMy WebLinkAboutZ-10504 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
` Southold, N.Y.
Certificate Of Occupancy
No....z105A.4 Date M$Y. 29 19 81
THIS CERTIFIES that the building .
Location of Property 50. Eigneyauckl®, Lane t _ , , , , , , , . Cutchogue, N . Y ,
House No. Street Ham/et
County Tax Map No. 1000 Section ..103.......Block ~ ? .........Lot ~ ~ .
Subdivision ......................Filed Map No. ........Lot No. .
r uir m nts f o e-Pa ily dxelliag built prior to
conforms substantially to t~i~.r~pp~tcatuw-fos~uii~ing~ew~tE~ereEefere~filedtintltisvffiee-dated~-^
April 23 57 C rt~fi at of, ccupaacyy10504
, 19 . pursuant to w~itch~eal~mg~errmt' o . .
dated .......r'3Y. ! 19 8.1. ,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. Duelling With. ~tOra.Be . Stied .
The certificate is issued to Aor.pxhy..C.. ~.~4et, , , , , , ,
(owner, leasrearl8naatL-
of the aforesaid building.
Suffolk County Department of Health Approval N/R • •
UNDERWRITERS CERTIFICATE NO...... N/.R .
C ~ ~`G~ .,(t
Building Inspector
Rev. 1/81.
BUILDII•:G DE.pAF.T2•~c.I.7T
T0~•.~: OF SGUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
LOCatlon 50 Hone suckle Lane
nuWber & street iunicipality
Subdivision Map No. Lot(s)
Nase of Ormer(s) Dorothy C. Fleet
Occupancy R-i
type owner-tenant
Admitted by; Self Accompanied by: Self
Key available wickhams office Suffolk Co. Tax No. •103-11_20
Source of request Stephen F_ Cr;ff;na, sr Date Anr;l ival
DDI~.LING
Type of construction Wood stories 2
Foundation poured men t. Cellar F„~i Crawl space
Total rooms, 1st. F1 4 2nd. Fl 3 3rd. F1
$athro::m(s)_ 2 Toilet room(s) ,
Porch, type Deck, type Patio, type
$reezeway Garage 2Car Utility room
T}~pe Heat oil Firea 'rlarm Air H0.tW3t:er__ Steam
Fireplace(s) 1 No. Exits 3 Airconditioning
Domestic hotwater yes Type heater Tankle~G
Other Electric heat panels in den.
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const._ wood '
Sti•~imming pool Guest, type const.
Other
VIOLATIOP:S: Housing Code, Chapter 52
Location Description. Art. Sec.
1-
Remarks:
Inspected by: (~~~~'~/5!!,-.~7~-~_Date of Insp. May 27,1981
. `xrtis W. Horton Time sl;art11:45 end12:15
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 $1.00
Date April, 23 1981,,,,,,,,,
New Building .............Old or Pre-existing Building x Vacant Land .
Location of Property ,old Pasture Road, Cutchogue, NY
House No. Street Hamlet
Owner or Owners of Property , DorothX C. Fleet, Individually & as Executrix of Henry L.. Fleet,
Estate, Deceased & Ann Fleet Malin & Sally Fleet Boenan, as Co-Trustees of Henry L. Fleet,
De as 103.00 11.00 020.000
County~ax ap No. 1000 Section Block Lot .
Subdivision .................................Filed Map No. ..........Lot No. .
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval j
Request for Temporary Certificate .....................Final Certificate ~ I
l~~l
I
FeeSubmitted$ 5,.00,,,,,,,,,,,,,,,,,,,,,,,, ~ S
Construction on above described building and permit m is all applicabl des regulaf s. ~ ~1J
Applicant h~',
STEPHEN F GRIFFING, JR., As A ey\for ers
Rev. 10-10-78 )
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