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~ ]~