HomeMy WebLinkAboutZ-10534FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No ..... ~, .105.34 ...... Date ..... J. une..I[3 .................... 19.8 .1
THIS CERTIFIES that the building ................................................
Location of Property ....4.1.7.0. Ir~.d.~ela..l~e~k..htto.e.~ ......... Pp.c. qoil.~.~..1~014..l[QI'k .....
House No. Street Hamlet
County Tax Map No. 1000 Section .... .0.9.8. .... Block ........ q 1. ..... Lot ...... .0.q~ .......
Subdivision ............................... Filed Map No ......... l.ot No ..............
vequivemtns for a one family dwelling built prior to
conforms substantially to the A~plieatio~-fo~-lh~ldi~.P.e~rail.her~ol;ot~. t~a;i .in.thin.office. dated._.
Cevtif.lcate of' Occupancy
...... fl. p. r.t.1.. 2. .3 ...... ,19..5. ~ursuant to which'g'm'lai'nl[l~r 1~.''. ......... Z l 0 5 3.4 ....
dated .... .J.u.n.e...2.3. ............... 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 .........
Private One=Family Dwelling with Eight Accessory Stvuctuvee
The certificate is issued to ......... !~.~h~t?. (1. A... [(pll ................................
[owner, levee er-teReRt¢ - - -
of the aforesaid building.
Suffolk County Department of Health Approval ...... .N/.R. ................................
UNDERWRITERS CERTIFICATE NO ...... I~ ./it .........................................
Rev. 1/81
BUILDING DEPAET;'~NT
TO¥,~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 4170 Indian Neck Lane,
~number & street)
Subdivision Map No.
Name of O~mer(s) Richard A. Kull
Peconic, New York
(Municipality)
ot(s)
Occupancy R-1
( ype)
Admitted by: Mr. Kull
Owner
{owner-rent-,t)
Accompanied by: Mr. Kull
Key available Suffolk Co. Tax No. ·
Source of request Richard A. Kull Date12/~2/80
DVfEI.LING:
Type of construction
Foundation Cement Block
Total rooms, 1st. Fi ~
Bathroom(s)
Wood #stories
Cellar Partia~rawl space
2nd. F1 3rd. F1
Toilet room(s)
2
Rest
Porch, type Roof over
Breezeway.
~/pe Heat Oil Fired
Fireplace(s)
Domestic hotwater Yes
Other
Deck, type
Garagg
Warm Air
No. Exits
Patio, type__
Utility room ~x
Hotwater x
Airconditioning
~YPe heater Tankless
ACCESSORY STRUCTURES: 8
> _Barn '
Garage, type const. Wood, large -~%9~age~ type const.
S
hpp ~
-~w~F~_~g-~l--Wood 2 Story Guest, type const.
Other 5 other are building=corn crip, labor building, outhouse
and 2 chicken coops.
VIOLATIO,WS: Housing Code, Chapter 52
Location Descriotion Art Sec
Gas Stnve no ~hnt off V 57-~9E6
Back Door Door sill rotten III 52-31-B
Front Porc!~ Needs ~]ot ~f re~.~ng rTZ. 57-31-R ~
roof, deck~ steps. ....
Labor Building Poor Shape ' III 52-31-B +
2 ~b~o- ~p= Need Repairing III 52-31-B +
Remarks:
Curtis Horton Time start2: oo end 3: 15
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 installa-
tions, 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.
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 unusua~ 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date.. (..~ ./~..~..2~ ./~...~..~. .......
New Building ............. Old or Pre-existing Building .....~..~i .... Vacant Land .............
Location of Property...~. ( .~. ?. ..... .~..~/..~.f.' .~./!~./~?.~,..~..//.(/..~..~./.(./'..~../.../~..c~...~:..~. ~/../,'.~.
House No. Street Hamlet
Owner or Owners of Property ...~.fl .~. ,~.'..~..~...O~..- ./~......~.~.~... ~..~. ..........................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
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 ..... . .~... ..........
Fee Submitted $....~. :.?...O ..................
Construction on above described building and permit meets all applicable codes and regulations. Applicant... ~~....~..'.~...~. ~ .........
Rev. 10-10-78
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