HomeMy WebLinkAboutZ-10799 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z10.7.9?......... Date .......D,eceryher. 3., 19 $1
THIS CERTIFIES that the building .
Location of Property ...7.600 .............P.QG9ri,q , ~sy, ,Rl,vd,. , , , , , , , , , Mattituck
House No. Street ~ ~ ~ ~ ~ Hamlet
County Tax Map No. 1000 Section J 2.6.........Block . 1 1............Lot ..0,1,3 , , , , , , , , , , ,
Subdivision .....XX ........................Filed Map No. X.......Lot No. .X.......... .
Requirements for One. Family Dwelling Built Prior to
conforms substantially to the Applicet~ea•€ar-Bttilai~-Pet~rit 1~rebefore.f~e~d-irr.tftis-affrcedattet
Certificate of Occupancy
A.Rri1..23..... , 19 57. pursuant to which Buti~~it No. ~.1.Q7~9.. .
dated Da.cembex:.3........... 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 .
...4, private ,ope. ,family, dwelling, ,two ,car .~;ara4~e and attelai:e:i storagg
area, and small wood storage structure.
The certificate is issued to .....Rpbert, H,.. Katharine, S... Koch
(owner, /exeew tewand .
of the aforesaid building.
Suffolk County Department of Health Approval NJ.R .
UNDERWRITERS CERTIFICATE NO ~1.R .
Building Inspector
Rev. 1/81
J BUILDING DEPARTrTEIrT
TOki; OF SOUTHOLD, N. Y.
FIOUSING CORD IP~~?ECTION :?SPORT
Location Ba Blvd
(nuWber & street) (i•iunicipality
Subdivision XX A4ap No. X Lot(s) X
ivTa:.,e of O:mer(s) Robert H. & Katharine S. Koch
Occupancy unoccu ied
typ e ( owner-tenai,t )
Admitted by: Bob xo~h Accompanied by:~same
Key available Suffolk Co. Tax iJo. 1.26-1 1 -013
Source of request A. Thomas Beasley Date 11/30/81
Di'~,LIitiG
Type of construction wood framed ;`stories 2
Foundation cement block Cellar full Crawl space
Tctal roons, lst. F1 5 2nd. Fl 3 3rd. Fl
Bat'r_ro:,m(s) 2 Toilet room(s)
Porch, type Deck, type wood Patio, type
Breezeway Garage Utility room X
Type Heat eas 'alarm Air Hotwater X
Fireplace(s) 1 No. Faits 4 Airconditioning
Domestic hot•,•~ater yes Type heater gas
Other
ACCESSORY STRUCTURES:
,Garage, type const.~ car & Storage, type const._small wood
Swimming pool attached stora~~jest, type const.
Other
VIOLA`i'IOi:S: Housing Code, Chapter 52 •
Location Descri>,tion Art. Sec.
No violations• Housing Code, Chant
Remarks•
Inspected by: ~7~~n~-Date of Insp. Dec. 2 1981 '
Curtis W. Horton Time start 3:00 end 3:30
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-
torwith the follovving; 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 installa-
tions, acertificate 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 peoperty 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 informa-
tion 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 ~~3a~~~ .
New Building .............Old orPre-existing Buppilding Vacant Land,............ .
Location of Property .~.~G~.~1~............./.f.~o~1i.~..~.s~ ,C~~r~~!:...~7~rr%/.Y.~~
House No. ,~rte Street ~ Ham7et
Owner or Owners of Property rSG'~E~PT/y . ~ /f ~%~/,i92/.I/G` S.,~~ . . . . . .
County Tax Map No. 1.000 Section ..~-2~......... Block Lot . ~~.3 .
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 ....~l................. .
Fee Submitted $ ;S .
ff~~ Construction on above described building and permit meets all applicable
c/od~es
and regulations.
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• Unauthorized alteration or addtion tothk stmayb aviota-
' lion 01 section 72C9 of the New York Stets Education taw.
_ , - CApies of this survey map no; Searing the land Sttrveyor'e
inked seal or emt+osssd seat shag not (m considered to be e
valid copy.
' Guarantees orceriificaGOns:n-f-~tadhereonshetlrunonly
to the person for whom C~~ prepared, and on his
behalf to the title company, yc.r::.•-f ntat agencyandlen-
/ O 00- /26- O/1 - O/3 ding institution listed hereon. a the nrsignees o! the
fending institution. Guarante>s crr..t,-,Eons are not
transferable to additional instit.,::ans or s~~i;;~usnt owners.
SURVEY FOR
ROBERT H. KOCH ~ KATHAR E S. KOCH
AT LAUREL - of NEty •
7C'b`dN OF SOUTHOLD y,~P~~gERi A. Kg9lO,p ~ GUARANTEED TO+ ,
SUFFOLK COUNTY, N. Y. ~t ~ ~ NORTM SHOR£A85TRAtT-LTD.
,F ~ * OBERT H. KOCH 9 KltTMA,grN£ S. KOCH
~CALE~ Irr=50r ,'nt,I ~
2S~ rS 2E725 J~ ..,.t_,,,X -1 ~-1.- ~
~ LAND 5~~ L.LhiD !Uf L E'r.7