HomeMy WebLinkAboutZ-4906FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No..~6 ..... Date .......... Nove~lber..17 ..... , 19.72
THIS CERTIFIES that the building located at Little. P. econie. Bay. Rd.. &.
Map No. Naasau. ~t. Block No .... D ......Lot No. ~.~.~ ..... ~tcho~. N,Y, ........
~,eme~r ~r-~ilv awell~e.& ~uaina ,e r me t f . o f 1 d el .& u
conforms substantially to the
b~efo.re-Aprll ~.3 ..... , 19.~7. pursuant to which --" ~ ~ & '~9~'
dated ...... ~o~e~ber... J~., 19.72, was issued, and conforms to all of the require-
ments of the applicable provisions of ~he law. The occupancy for which this certificate is
issued is .. Pr. Irate .one..family. d~elling ......................................
The certificate is issued to . .Rob. err. g., .K_~.tpskt..& .Wife. Lind& .... .0~mers .......
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .Pro.-.oxls.~l~g ....................
UNDERWRITERS CERTIFICATE No... pX'~-. OXJI. 8~;]J~.g ................................
HOUSE NUMBER.. (~.~ ....... Street... Lt.tt].e. Poaollt~..]~t~'..Road ...................
Building Inspector
HOUSING CODE INSPECTION
November 8, 1972
645 Little Peconic Bay Road
Cutchogue, N.Y.
Subdivision: Nassau Point Club Prop., Inc.
Ma~ 806, Section D, Lot #417
Tax Roil: Robert J. Krupski
Occupied, owner
Upon request of the Southold Town Building Department
I made inspection of this two story framed dwelling and
fQund no violations of Local Law #1, Housing Code of the
Town of Southold. I began inspection at approximately
3:55 p.m. and completed at approximately 4:10 p.m.
ect~ubmi~tted,
~-~wara Mlnaermann Inspector
EH:tle
FORM NO. 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.
New Building .................... Old or Pre-existing Building ........ .x.. ................. Vacant Land ............................
Location Of Property corner of Little Peconic Bay Rd & Haywaters Rd, Nassau Pt
Owner Or Owners Of Property Robert J. Krupski and Linda Ellen Krupski
Sec D Nassu Pt Club Prop. ' ' No 417
Subdivision ................................................................ LOt ............. Block No ............. House No .......
Permit No ......... .~-~ ...... Date Of Permit V/~ Applicant ........ ~ ................
Health Dept. Approval ...... t ..................................... Labor Dept. Approval ................................................
Underwriters Approval ......... P~ .................... Planning Board Approval ....... ,..~....:[...'.~,.. ..................
Request For Temporary Certificate ........................................ Final Certificate ...~ .....................................
Fee Submitted $ 5.00
Applicant ............ ~~.. ,~.,~:~-/ '///~ ~"~ .............................
Sworn to before me this ' Ga~zv/Flanner Olsen, as Attorney ..........
................ day of ............................................
Notary Public .................................... County
(stamp or seal)
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