HomeMy WebLinkAboutZ-13433FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. 3A $ ..........
Date .... ~Ag.J~ ............... ....... 1~.5..
THIS CERTIFIES that the building ..... O.b.E..F.A.M..I.L.~..D. ~.E.L.L.I. ~9 .....................
Location of Property .... .1.2.0.q..F.a.c.~.q?y' Ave. &. 75.q .0..a.k.P. 1..a.ce ...... .M.at. ti .guck .
House No. ' ....... Street .......
County Tax Map No. lO00 Section ............ Block ............... Lot .................
Subdivision ............................... Filed Map No ......... Lot No ..............
Requirements for a private one-family dwelling built prior
conforms substantially to the X NO X O X KBma I mmK [O eX N X wTat eXffa/ XX
CERTIFICATE OF OCCUPANCY
.... A. p..~ .~.1.. 2. .3 ......... 195. 7.. pursuant to which ~t{&il6~ l~xl~tKl~o.. # Z. 1.3 4 3 3 ............
dated .. [q.aj.. J 3 ................... 196.5.., 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 2 CAR ACCESSORY GARAGE.
The certificate is issued to .d.O..A.N.N...6.R?.T.H. ?.0.H.L. ,...S.Y.L.V..I.~. ?.0..U.S.E. ,...J.~.R.~.g..T.T.E..C..A.IE .....
(owner, X~.{~i~ ~(r:~.n:~/~)
of the aforesaid building.
Suffolk County Department of Health Approval .... .N.0.. R..E.~.O.R.D. ...........................
UNDERWRITERS CERTIFICATE NO. N 0 R E C 0 R D
PLEASE SEE ATTACHED INSPECTION REPORT
Building Inspector
Rev. 1/81
BUILDING DEPART~,~E~T
TO%'fN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 1200 FACTORY AVENUE & 750 OAK PLACE MATTITUCK
(numDer & street)
Subdivision
Map No.
(Municipality)
Lot(s)
Name of Owner(s) JO ANN GRATHWOHL, SYLVIA ROUSE, JEANETTE CAIN
Occupancy R-1
A~mitted by:
(6ype)
MRS. ROUSE
UNOCCUPIED
(owner-tenanZ)
Accompanied by: SAME
Key available
Suffolk Co. Tax No.142-1-9
Source of request
MRS. SYLVIA ROUSE'
DateMAY 9, 1985
D~LLI~,IG:
Type of construction
Fo~uqdation Cement block
Total rooms, 1st. FI 3
Bathroom(s)
Porch, type ~lassed in
Breezewa~
Type Heat oil fired
Fireplace(s)
Domestic hotwater
Other
WOOD FRAMED #stories 2
Cellarpartial Crawl space rest
2nd. Fi 2 3rd. Fi
Toilet room(s)
Deck, type
Garage.
Warm Air central
No. ~cits 3
Yes
Patio, type
Utility room
Hotwater
Airconditionin~
~ype heater Gas
ACCESSORY STRUCTURES:
2 car
Garage, type const. Cement b~ock Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter kfX~45 N.Y.S.U.F. PREV & BLD CODE
Location
CELLAR
Descriotion
NO RAI~ CELLAR STEPS
UPSTAIRS RATI, UP T~, NOT r~QNTINI;OII.~
Art. I Sec.
J1242.3d
1242.,3d
Remarks:
'Time start 8:30 endfl:45
CURTIS W. HORT~
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
,~'~uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
in duplicate ,
A. This application must be filled in typewriter OR ink, and submitted ~ ,V, ~:~:o' zhe Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property dnes, 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, 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.
Bo
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of pzoperty 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 preoare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
$15.00
4.Vacant Land C.O. $5.00
Date .. ~ ~ ...............
New Building ...... ". ...... Old or Pre-existing Building .....t~.. ..... Vacant Land .............
Location of Property.../.~.O..~. ....... .~..r.~....~..,~.~.~.~.~.,~.~..~../.././..~?...~....~.~..~././.,.~.; ....
House No. ~ ~ ,Street ¢ Ham/et
County Tax Map No. 1000 Section ../...' .~ ....... Block ....... ~ ....... Lot ..... ~ ..........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Fee Submitted $ .'~'./.~, ~. C~ ...................
Construction on above described building and permit meets a~?pplicable codes and regulations.
Applicant......~ ~'..~...~.~'.~
Rev. 10-10-78 ~//
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