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HomeMy WebLinkAboutZ-9762FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. ;9762 ......... Date .... N4�/effibex' 26 ............... 19n. THIS CERTIFIES that the building .... ........................ ............... . Location of Property�"- .'kee 'haliaRoad ........ ............ House No. Street Hamlet County Tax Map No. 1000 Section ..Q7 ........ Block .... 01Q .......Lot ..... 2.......... . Subdivision ......... Filed Ma No. of No. . . regti a ea►exits 'tor' a oni �y dwelling b�iia. prior to conforms substantially to the 'llPF90116111 -Z M I Nov long MAIN ... Apr:4 g3........ , 10..7 . pursuant to which99No. ......... Z9762.. . dated ..Novembor .2g• • • • • • • • • • ... 19 !�� , 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 ss&Uy Drellftx x/attached e The certificate is issued to .......:a S en* • • • • • • • • • • • • • • • • • • (owner, . 9 MAIN 601 0811-11 1� of the aforesaid building. Suffolk County Department of Health Approval .............. X....................... . UNDERWRITERS CERTIFICATE NO ........................ .......................... Building Inspector Rev 4/79 FORM NO. 6 TOWN OF SOUTHOLD 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 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 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 Date ...���'��^!. ................. New Building ................ Addition ................ Old or Pre-existing Buildin lJ�,...... Vacant Land .............. Location Of Property �.C.hS!Q�!�/1`��- �.�.... ���'"�'' lU� ................ . .................. ..... ............... .... .......... Owner Or Owners Of Property ...... ............ ................................................. Subdivision................................................................ Lot No............. Block No............. House No............. Permit No ..................... Date Of Permit ....................Applicant.................................................................. Health Dept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ...... Fee Submitted $ .................................... Construction on above described building and Applicant Sworn to before me this ................ day of ............................................ NotaryPublic .................................... County Final Certificate _—, ......... codes and regulations. (stamp or seal) BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location Z-5--00 number & street Subdivision Map No. c -A- Municipality Lots) -- Name of Owner(s) Occupancy type owner -t nt Admitted by: A:F Accompanied by: <7�et Key available Suffolk Co. Tax No.•[000- o 7, 010 • z Source of request ,G/ ,?� Date /Vo v Z / ' 7 DWELLING: Type of construction IU000 T�,/-/�F _#stories o<vc Foundation— ,�/ock Cellar i--�;%/ Crawl space Total rooms, lst. Fl 6 3 B 2nd. Fl 3rd. Fl Bathroom(s) oaz c. 7c,// Toilet room(s) — Porch, type Deck, typePatio, typeCx,e . Breezeway Garage Utility room Type Heat� —darm Air Hotwater of e-- f &0;0 Fireplace(B-j Exits T a Airconditioning Domestic hotwater >,L.S • Type heater g LF-��55 Other�%o�-��.v�� i ���5 �.� i . Ail V oA ACCESSORY STRUCTURES: Garage, type const. Storage, type const. Swimming pool Guest, type const._ Other VIOLATIONS: Housing Code, Chapter 52 1©v/vIo Remarks: Q / / Inspected by:2.0 Date of Insp. Time start7- /9 endo = `/o