HomeMy WebLinkAboutZ-10711FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
5outhold, N.Y.
Certificate Of Occupancy
Z10711
~o ..................
Date October 2 81
THIS CERTIFIES that the, building .......................... . ......................
Location or Property .. 799.7.s...~.ay.n...ap.a.a., ........ .o.r.x. ?.n.t.,...~.o~ .¥.or.k' ..............
House No. Street Hamlet
County Tax Map No. 1000 Section . .1. 7. ........ Block .......... 3. .... Lot ....... .5. ........
Subdivision ........................ ~ ....... Filed Map No. .Lot No ..............
Requirements for a Private One-Family Dwelling Built
conforms substantially to the~1y~a't~m~fm~-I~'tff~e1i.r~g~Pewni~t~h~f.m~fi~t~i~t~his~ffi~-
Prior to
Certif~oate o~f Oc_cupancy Z10711
· ./~p.~.~].. ~.2t .......... 19 ;5.7. pursuant to wl~ic'h-trtri'l~i'rtg'r-er~rri'c ~.--. ....................
dated ... 9.e.~°..b??. fi. .............. 19..8.1, 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-Family Dwelling
The certificate is issued to
of the aforesaid building.
Isaac T. Edwards
..................... ?o¥,,'~;, ~'~,~'ffx'~ ~ ..................
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO. N/R
Building Inspector
Rev. 1/81
JiOUSTNG CODE !N$?ECTIOI',' REPORT
Location 20075 Main Road__
tnumber & s~r'ee%)
Subdivision
Map No.
Orient, New York
(~,Iunicipality)
Lot(s)
Name of O',mcr(s) Isaac T. Edwards
Occupancy R-i
(typ~-
Adm.,itted by: .Mr. Edwards
Key available
Tenant
owner-'tena~,t
Accompanied by: Same
Suffolk Co. Tax No. '17-3-5
Date Sept. 16/81
Source of request Issac T. Edwards
D?~,LIi:G:
Type of constr,.lction
Fo~mndation Cement
Total rooms, Ist. Fi
Wood
#stories. 2
Cellar Partial Crawl space Rest
2nd. F1 4 3rd. F1
Bathro~.::(s) ~
Porch, type
Breezeway
Type !.~eat O~l Fired
Fireplace(s) 1
Domestic hotwater
Other Wood Burner
Toilet room(s)
Deck, type Wood deck Patio, ty-peCe~nent
Garage 2 Car Utility room
Warm Air Hotwater x
No. E>:i [~s 4 Airconditioning.
Yes Type heater 0il Fired
ACCESSORY STRUCTi~RES:
Garage, type const.
Swimming pool
Other
NONE
Storage, type const. __
Guest, type const.
VIOI,ATIOi:S: Housing Code, Chapter 52
Loca 2ion Descrir~tion Sec.
ToiIet Re(
m Toilet not finished
52-32-D
Remarks:
T ~'~ '~ /~ ~ ' ~ ~
_n,:, ....tel by:_~_Z_~/~i~_L__Z~_~--.__?~e Of Insp. 9/17/81
Curtis W Hortom [F'..,~ ~-~-~"- 2:30 end 3:00
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
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 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 s~milar 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.
\ -
(prior April :1957), Non-conforming uses, or buildings and "pre-existing"
B. For existing b~uildings to
land uses:
1. Accurate survey of peoperty showing all properly lines, streets, buildings and unusual natural or
topographic featu res. ~"
2.Sworn statement of owner ~r previous owner as to use, o~,cupancy 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. ~
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date.../..~.'~ .'..~ .~..~. f ........
New Building ............. Old or Pre-existing Building '~' Vacant Land
Location of Property /4,)~[.
House No. Street Hamlet
Owner or Owners of Property . .,~7~..~.. ~..-..~.~.4~:2~;~,~.. ~ .....................
County Tax Map No. 1000 Section .. ~,)../.~. ...... Block...f,~. ~. ....... '/'' Lot..C:~.,,~.'-~..'~.~..~'
Subdivision
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 $. ~'. ~.~.~ .....................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant . ,~.~.~..~... ~'~,~,~,(~-:'. ..............................
Rev. 10-10-78