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Home My WebLink AboutZ-4626FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No Z4.U6....... Date .............. May .. 2 ...... , 19 . q2. THIS CERTIFIES that the building located at .. poser4a ."~...Blvd ...... Street Map No. .XX......... Block No. ..x...... Lot No.. X= ... Ss►run►1 .x •y.r .......... regu resents for one family dwell using cede conforms substantially to the - -_-- _�_r__ _ _:_ _� _ DVA"dP *O7r .April .. 23 ... 19.5.x. pursuant to which � . C/p .Z 26 dated ........ May ....... 2... , 19.72., 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 ... Oboe • fsaiily. dwelling .............................................. The certificate is issued to . • •E3.sie . jerred" " ' • • •uwnor...... • • • • • . • • ... • . • (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..prSeX jStj.ng.................... UNDERWRITERS CERTIFICATE No... f ............................................. . HOUSE NUMBER.4895 ....... Street ... arsat.peoenie. Bay. Blvd .................... Zzeeption to Housing codes electric Connection to water puny should be "HZ" or Ron" mire with ground. Several "Jury rigged extension cora outlets~ should be perminently wired outlets Building Inspector HOUSING CODE INSPECTION May 2, 1972 4895 Great Peconic Bay Blvd. Laurel, N. Y. Tax Roll:- Elsie L. Jerred Occupant:- Mr. & Mrs. John Longo Upon request of Building Dept., Town of Southold, inspection was made at the above address by myself and associate George Fisher. We arrived at aproximately 3:00 P.M. and were admitted to this one and one half story:^framed dwelling by Mrs. Longo. The following violations were found in accordance with Local Lai[ #1 1967 Housing Code of the Town of Southold. BASEMENT :- Motor on water pump, electric hook up, drop line cord to common outlet, Sec. 528 a. Light socket over former washing machine (laundry) location, lamp cord to common out- let, Sec 528 a. METAL ACCESSARY BLDG. REAR YARD:- Light socket with lamp cord running through rear of unit into basement window of dwelling to common outlet, Sec. 528 a. We completed this inspection at aproximately 3:40 PM. R'sp6ctfully submitted, FORM N0.6 TOWN OF SOUTHOLD Building Department 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 of 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`........y./...4..�..�.. New Building .................... Old or Pre-existing Building ................... Vacant Land ............................... Location Of Property ... .5 ........ �? ...... /� Y G V Z) ...... �. u.(Q :>...../...... . t7 '. ........... ..r...... ..... ..... . ... .......... Owner Or Owners Of Property 9.4:.tl' l --2 L.:. V . l a Q:. v ..................................................... Subdivision................................................................Lot No............. Block No............. House No............. PermitNo ..................... 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 rmit eets all P le c es and regulations. Applicant....... . .......... ........ .......... Sworn to pbefore me this C. tel( day of .....Jll ly.....47` ..... (stamp or seal) Notary Pub l} `Ik�Z�. r!:•�C.� my STOYL O Ti ---------- 11 ev s/ w I � �� .� / -� _ �► it .� J I