HomeMy WebLinkAboutZ-6718 FOB~M NO. 4
-TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
.Southold, N. Y.
Certificate Of Occupancy
No. M .67~ 8 Date Sepa 3Q 19 75 .
THIS CERTIFIES that the building located at E,l. hsnx~ey .&d............ Street
Map No. ~ Block No.X~........Lot No...x~....Southo7.d...~ rX.% .
conforms substantially to the a irQme t~ f f8 1 e] . Fc l;o ~n code
d~t• before •.~pr3]. • •I t195~.. pursuant to which~~X~~~Op~691$ C~
dated ...........Septi ..3SI..., 19.75.., 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 ~'riyate ,one, .family, dwelling, :kith .two. accessQpy hu~.ldings , ,
The certificate is issued to .8abnrt. J...~ olger... , os~mer .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval pre-„existing, , , , , , , , , , , , , , , , , , , , ,
UNDERWRITERS CERTIFICATE No. .pre-esisti,tlg . . .
HOUSE NUMBER ...212.0....... Street $enxiey..i.3oad .
Buildin Ins •eCtO~
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HOUSING CODE INSPECTION
September 29, 1975
2120 Kenney's Rd. R-3
Southold, New York
Tax Roll: Robert J. Kolyer
Occupied: owner
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy I made an inspection of this one story framed
dwelling. I was admitted to building by Mr. Kolyer who
accompanied me during this inspection which began at approximately
2:20 P.M.
The building consists of three bedrooms, kitchen, bathroom,
living room and an enclosed rear porch Heat is furnished to
building from an oil fired warm air furnace located in living
room floor.
Accessory structures consist of a small building located in
front yard area on northwest corner of property. This building
has a non-conforming use as a real estate office. A large utility
shed is located on the southeast corner of lot. Fences consist
of a six foot stockade along rear yard line and a split rail
fence along right of way.
There were no violations of The Housing Code, Chapter 52,
Town of Southold.
Buildings and structures are in good order. Inspection com-
pleted at approximately 2:40 P.M.
Res ectfully sub tted,
• n,
(.w~-~-_
EH:mm Edward Hindermann
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Deportment
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 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 os 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
Dote~/
New Building Addition Old or Pre-existing Building .,~,Vgcont Land
Location Of Property ."T"'""...~~.....
Owner Or Owners Of Property ..l.C:.A~:I.I. `........Y.:.._... f
Subdivision ...............~........................................Lot No....~...... Block No. .House No.............
Permit No. Date Of Permit .......:.\........A licant
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Health Dept. Approval ....~~j~~.'.^..`...t ::..............Labor Dept. Approval ......G~-~`~"./..`.'..~I
Underwriters Approval .....ll,/.~:°.... ~::?::............Planning Board Approval '
Request For Temporary Certificate Finnl Certificate ~M~
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Fee Submitted $
Construction on above described building and' it eet; pl ap codes and regulations.
Applicant
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Sworn to before me this ~ _ ~ ~ t ' `
day of (stomp or seal)
Notary Public - County G~-~ ` ` p