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HomeMy WebLinkAboutZ-4890FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy ..... Date ............. .~.~.... THIS CERTIFIES that the building located at . }~T~ .-~FO .............. Street Map No.. ~..1~..?e~lock No ........... Lot No. ~..~ ].1. ~..~ 2.t.. ]. ! ~.~.. ~0.~. H.*Y · ~~t~ for one f~ dwel & ho~ ~e conforms substantially to the b~lt before A ril ~ Ce~eate of oee~ey ~ ........ P ............. , lS.~? pursuant to which ~ No. ~0.. dated ........ N~Y~b~r .~..., 19.~2., 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 .. Pr..~.v.a.t.e..O .n0..~.t~..t .~..d.v.e.~.~..~. ...................................... The certificate is issued to . .1~..~..t.e.r..G.~..~....&..0..the. r.s' .... . .0~.~...~. ! .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....Pr..~.....e~..s.t.~..n&.. ................. UNDERWRITERS CERTIFICATE No...PF..°~.°..~. S.~....;~. .................................. ItOUSE NUMBER...'l~.0 ...... Street.....~t~....~'...~.?O. ................................. ExQeption to housing eodel 1. no shutoff at gas range appllena® ~08b Building Inspector HOUSING CODE INSPECTION November 1, 1972 Tax Roil: Unoccupied #1350 Bayview Avenue Greenport, N.Y. Subdivision: Summer Haven Lots #111 to 113 inc. Walter Grimm and ano Upon request of the Southold Town Building Department I made inspection of this one story, three bedroom framed dwelling with attached one car garage and found the following violation of Local Law No. 1, Housing Code of the Town of Southold. After picking up keys from the Dickersen Real Estate office, Southold, I began inspection at approximately 3:30 p.m. by letting myself in through front entrance to living room. Kitchen: No shutoff valve at gas range Section 508b. I completed inspection at approximately 3:50 p.m. and returned keys ~to real estate office. ~c tfu~ s~mitted, Inspector EH:tle ~OEM NO. 6 TOWN OF $OUTHOLD Building Depmtment 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 triplicate 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 o'f 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 Nov. 1, 1972 New Building .................... Old or Pre-existing Building X Vacant Land Location Of Property ................~ay.~zieu~..~..v. ez~.~e,...~.o~czt..of..S~u~hol~r..N~vc..~<~l~k ....................... Owner Or Owners Of Property .... ..~...~....~.....~....~ ....................................... 111-113 incl. Subdivision S~ae~'..I-Ia.v. en...~Lata.#,l.L33 ........... Lot No ............. Block No ............. House No ............. Gottlieb J. Nickles for Permit No ..................... Date Of Permit .................... Applicant ..... .G...u...s....F..i..s..Ig.~.~,...~.q ........................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....P...r..e....E...x..i..s.i..i..n.g ............. Fee Submitted $ Construction on above described building and perrr,~t meets all applicgbl{ c_odes ppd_regulations. Applicant ......... .~..... ~..-i.'.--~ ..................... Sworn t~efore me ~l~is~ / .... / ........ day of ..~ .~~ Nota~ Public ...~ ...... Coun~ ~RGERY ~mmiffion ~xpire~ March ~0~ ]~