HomeMy WebLinkAboutZ-9890 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No... ?9890 March 4. 19
Date
THIS CERTIFIES that the building .
Location of Property ...'s.2~00 ,Main Road , , , , , , , , , , ,Orient,, ,N.Y.,
House No. Sheet Hamlet
County Tax Map No. 1000 Section ~~9.....Block ..........Lot ......011,.,1 , , , , ,
Subdivision ...............................Filed Map No. ........Lot No. .
requirements for a one family dwelling built prior to
conforms substantially to the
Certificate of Occupancy 29890
...April , 23, , , , , 1957. ursuant to which ~~4$ No.
p
dated ....March 4 , , , , ..1980. ,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 .
. ..........One Family Dwelling
The certificate is issued to Edward KOrOleski
~owner,~F~ll .
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO N/R .
~ . r.~..
~ U._,, .
Building Inspector
Rsv 4/79
FOB11i NO. 8
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 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-(5-9 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 .~S.fZ..... ~~.,....llr.~~........
New Building Addition O/l~d~ or Pre-existiyng~Building Vocont Land
Location Of Property .../.~<.tin....~[R~~.....G11:1.~,......./.(.~!°f4.t...f~P!'~"~ .............-.l,,zjUQ
/ 1 / 'e / / ,
Owner Or Owners Of Property .I.)P.~+~~....~.....~~~a~....1•~f!'•KY~7...~CW... ....r•~.~ro/4~f
SST /pOQ No..A./.,~... Block/No...41...... GW
erne No.. 0%~:
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 $ ~.ti..Q.~
Construction on above described building and~jp
rmit meets all applicable codes and regulations.
Applicant .......`:.:........~~..~..~-r
Sworn to before me this (r 0. z.9~9~
~~d
day of ~ (stomp or seal) 4~d
Nota P is Coun ~~'-0-~~/~
ry
WlLl1AM H. PRICE, !R.
pt'pRy' PL~Eai., STA7c Of NEW YORK
Suffolk County ~o. 4C>3~19~4
Yearrn E~lres Mar:h 30, 1931
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 3~3~ d /`~~/,v ~lz/~.~i - ~t/~y '
number & street Municipality
Subdivision L Map No. Lot(s)
Name of Owner(s) ~,~iv~ro ~a~/c`5~/
Occupancy ~ / Lll!/if1/Ct? I~2ol~~/~i
type owner-~bene11r~t
Admitted by: ~/j5 h~
/F~Accompanied by: ~COKCS/~~!
Key available ~ Suffolk Co. Tax No. job- o~ y'a!-p//. !
Source of request ~2~,rT F ~Q/~i~~F-2 Date Z-Z / - ~CJ
DWELLING:
Type of construction ~ ~ ~ #stories / ~L.
Foundation Cellar /~~'L Crawl space ,o L
Total rooms, ls~ F1T a 2nd. F1TN,o ~
~ 3rd. F1
Bathroom(s) / ~ fal/ Toilet room(s)
Porch, type Deck, type Patio, type---
Breezeway - Garage Utility room -
Type Heat (F,uTI~,oL Warm Air mee.. F~r~t~Hotwater
Fireplace(s) ,(~,c.~ No. Exits %k.rd Airconditioning -
Domestic hotwater y~'r Type heater ~LccT, l
Other
ACCESSORY STRUCTURES: l
Garage, type const.~y- Bvfc.cJ Storage, type const. (~(/oo6~r~4,(.fF
Swimming pool Guest, type const. -
Other
VIOLATIONS: Housing Code, Chapter 52
Location Descri tion Art. Sec.
ioi a~ ~ ~ 5z- Z
Remarks : ~ /c p O•cJ G,UOcrC. ,S - ? !
Inspected by: ate of Insp. 3~3/d~D
Time startz-tlo OI'~end.j~c~