HomeMy WebLinkAboutZ-10179FORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
5outhold, N.Y.,
Certificate Of Occupancy
No .... g~.Q!?9 .......
Date ..... .09.t.o.b..er..3.~. ................ 19..8.0
THIS CERTIFIES that the building ................................................
Location of Property 200 ¥illage Lsne, Orient, N.Y.
121[:>t~s'e )~o: ........................................................ Street Ham/et
County Tax Map No. 1000 Section . ...~.8. ...... Block . .. ~ ........... Lot ... 7 .............
Subdivision ............................... Filed Map No ......... Lot No ..............
reauirements for a one fami~ly dwelling built prior to
conforms substantially to the ~'ppl~c"a~on-for'Bui[dSng'Perrrrit-~ler~toiore-ffl~ff-i~r~ of~ce-'datetl--
.~-P~.ll 2~.~ , 19.. ~'ursuant to Certificet~, of Occupancyg10179
.......... which J~l~dJM~er~Tk-Nu.- .....................
dated ...O. ctohe, r. 3, .............. 19.8. Q, 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 .........
.... .0.n.e .F. am.ily Dwelli.ng with One Acc.e.s. sory (Non Habitable) Building
The certificate is issued to Rode M. HR] e
..................... ?o;(,,;o.r,.l~¥~.:~,.7~Orxz ...................
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO. N/R
Building Inspector
Rev 4/79
BUILDING DEPART~ENT
TOWN OF SOUTHOLD, N. Y.
Location
Subdivision
HOUSING CODE INSPECTION REPORT
(n,mber & street) (Municipality
Map No. Lot(s)
Name or Ovmer(s)
Occupancy
Admitted by:
(type)
(owner-tenant
Accompanied by:
Key available
Source of request
Suffolk C0; Tax-Nol~
DWELLING:
Type of construction
Foundation
Total rooms, 1st. F1
Bathroom(s)
Porch, type /
Breezeway
Type Heat
Fireplace(s) /
Domestic hotwater
Other
Cellar
2nd. F1
Toilet room(s)
Deck, type
Garage.
'Warm Air
No. Exits
Type heater
#stories
Crawl space
3rd.. F1
Patio, type__
Utility room
Hotwater ~
Airconditi0ning
ACCESSORY STRUCTURES:
Garage, type const. /6/~ q Storage, type const.
Swimming pool -c~-~/- Guest, type const ~ '~ ~ ~/~
Other ~b,-~
VIOLATIONS: Housing Code, Chapter 52
..Location Description Art. Sec.
Remarks:
Inspected by:
Date of Insp. ~?~-I~ ~q~
Time start lQ ~ end /~ ~ 5~
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 featu res.
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.
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
topograph ic featu res.
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.
$5.00
v,~3. Certificate of occupancy on pre-existing dwelling or land use
Copy of certificate of occupancy $1.00
Fees:
1. Certificate of occupancy
$5.00
Date .. J. uly..R,. 19.80 .........
New Building ............. Old or Pre-existing Building .... .X.X ...... Vacant Land .............
Location of Property .. (.N..o..~.) .......~. ?..O ........... .V.i.l. 1..acj.e..L..a.n.e ......... O. .r .i.e. n. .t ........
House No. Street Ham/et
Owner or Owners of Property .... .R.o.d.e...H.a.l.e. .............................................
County Tax Map No. 1000 Section ...0.1..8 ......... Block .. 0..0.5 .......... Lot....0.0.7. .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ............................ ~ .....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $...1...0.0. ...................
Construction on above described building and pe, t/mit~ts/~"'~ all applicabl~es and regu~al:ions.
Applicant...../..~~ .......
G~orge C. S~anke~ich, Esqi'