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Home My WebLink AboutZ-8985NO. 4 TOWN OF SOUTHOLD BUll,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~.00. $£.Ivel~e.I'e. Rd, .... Street Map No ............. Block No ........... Lot No .................................. REQUIRtlvlENTS FOR ONE FAMILY DWEI.LING BUILT BEFORE conforms substantially to the ...... dated . .. Apl~.ll .... 23 ....... , 19..57 pursuant to which ~ . dated ...Apl?il .... 18 ........ , 19.78., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is PRr~ATE ONE FAWILY DWl~.T.II~ The certificate is issued to Florence Jurzenta of the aforesaid building. Suffolk County Department of Health Approval ........... P~.e?E~.~;ll~g .......... UNDERWRITERS CERTIFICATE No ..................... P.~'.e.-..F_~..~.~.~r~g .......... HOUSE NUMBER ...1.~O0 ....... Street ....... $~.lv. ermere. Ko. ad ................. ............................................. O~npor. t,. N~w.Yo~ ............ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFIGATE OF OGCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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: I. 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 Oote ......... ............. New Building ................ Addition .............. ~ or Pre-existing B~ .............. Vacant Land .............. Location Of Property ...~..../...~....~/....~....~..Z~...~...~....~.....~.~........~...~....~.~..~.~..~...~....~7...~/.~..~.~ ...................... Owner Or Owners Of Property .... ~--~,~,~--,~c~ Subdivision ................................................................ Lot No ............. Block No ............. House 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 $ .................................... Construction on above described building~ p~mi~t~//.,~ meets all(~'c_ablex/×/ codes and regulations. Applicont ~-~/ -~-~.~ ~ ~ ~,~ ~ ~ ~//_~__ ................... Sworn to before me this Housing Code Inspection April 18, 1978 1300 Silvermere Road R-1 Greenport, N.Y. Tax Roll: Florence Jurzenia unoccupied: Upon receipt of an application for a Pre-Existing Certificate of Occupancy I made an inspection of the building on this premises. I was aSmitted to dwelling by Mrs. Jurzenia and began this inspection at approximately 10:25 A.M. This dwelling is a one story wood frame structure constructed on a cement block foundation with crawl space. Ground floor contains two bedrooms, living room,full bathroom, kitchen with dining area, front entry hallway and a utility room. Heat is furnished to all rooms from an oil fired forced warm air furnace. Domestic hotwater is furnished to all plumbing fixtures from an oil fired hotwater water heater. These units are located in utility room accessible from within building. An addition constructed under Building Permit #2955Z to which Certificate of Occupancy #Z2510 was issued contains three bedrooms and two full bathrooms. This permit includes a deck on west and south side of building. I found no violations of the Housing Code, Chapter 52, Code of the Town of Southold, N.Y. Inspection completed at approximately 10:50 A.~, t bmitted, Building Inspector