HomeMy WebLinkAboutZ-11244FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No.., 112.44 ......... Date....Oct:aher..7................... 1982.
THIS CERTIFIES that the buildings...(2.)..........................................
Location of Property . ;:�.�� ...... Frl.vate. Ad. - A-9.,Fard! s..Road ..... S.nutho.ld ....
House o. Street Hamlet
County Tax Map No. 1000 Section .. 037. ...... Block ... 0.1 .......... Lot .. 0.15........... .
Subdivision ... X...........................Filed Map No. . X ...... Lot No. X ...........
Rilquirements for a private one -family dwelling built prior to
conforms substantially to the AppliGatie�a foa8uildil�gkeri�#�ereto€er$-flecktis e€ftee�lafed-
Certificate of Occupancy
April. .23 .........., 1957. pursuant to which Buil A*R--ffm4t No. .7.1.124.4 .............
dated ...October • I . • • ............ 1982. , 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 .........
• •a •pr•i•vatp. -one-family. Awn-llinfr. with- .accemsory..storage. ))+Iildinr.....
The certificate is issued to ....... R a•1•pl3 • P... _t . A na. L....Lamin ia.....................
/owner, lessen nrteoanAL
of the aforesaid building.
Suffolk County Department of Health Approval......n/a.................................
UNDERWRITERS CERTIFICATE NO..............n/a................................ .
G� ., ..W B n Ins ..................
Rev. 1/81
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-
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.
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 $1.00
Date .. Septentbe 1,4, �9$z
New Building ............. Old or Pre-existing Building ....$....... Vacant Land .............
Location of PropertyPrivate Road or Road) Southold
.......(Off........South.....Harb.. ...
House No. Street Hamlet
Owner or Owners of Property . ,Ralph E. ..Lavinia..and..Anna..L. ..Lavinia......................................
County Tax Map No. 1000 Section ....$7......... Block ........... Lot ....15 ..........
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 $.5 - 00 ........................
Construction on above described building and permit ogts all applicable codes and lations,
PAACO`L
. Applicant ..... /, . \- ` ; r�J% " t'
Ralph E. Lavin
Rev. 10-10-78K_��i` a 07_71v
/01?/&.2
na L. Lavinia
STATE OF NEW YORK:
. ss.
COUNTY OF SUFFOLK:
RALPH E. LAVINIA and ANNA L. LAVINIA, being duly sworn,
deposes and says:
That we are the owners of a parcel of land on a private road
off South Harbor Road, Southold, New York (Suffolk County Tax Map
No. District 1000, Section 87, Block 1, Lot 15). T,°Ie acquired
this parcel on September 21, 1964 from Mary M. Kilhofer (Liber
5622 Page 5E1).
Located on the property is a one --story frame house which has
been used continuously as a residence since approximately 1948.
so located on the premises is a separate shed. 111 of the
buildings are in good condition and have been constructed prior
to 1957.
This application is made for the purpose of obtaining a
pre-existing Certificate of Occupancy from the Building Department
of the Town of Southold.
Ralph F:. Lavinia-'
G�Gti�
na L. Lavinia
Sworn to before me this
14th day of September, 1982.
d4lAo,, odJe,aLvj
Notary Public BARBARA DIACHUN
Notary Pubfic, StatSeoke*V�
Np, 52.4635190
Com;n;sWn Expires March 30.198'
-S'TOWN OF SOUTHOLPERTY RECORD CARD
OWNER
A"a
ISTREET—
VILLAGEDISTRICT
FARM
1
SUB.
LOT
FORME lf OWNER
Nr
E
ACREAGE
REMARKS 4
4:f
Sgyp,w
TYPE OF BUILDING
RES.V/ 6�
SEAS,
1
VL
FARM
1
comm.
IND. CB. misc. Mkt. Value
1 1 1 1 Est.
LAND
IMP.
TOTAL'
DATE
REMARKS 4
4:f
7 -
AGE
BUILDING CONDITION
NORMAL j BELOW ABOVE FRONTAGE ON WATER
NEW
Farm
Tillable I
Tillable 2
Acre
i Value Per Acre
Value
FRONTAGE ON ROAD
BULKHEAD
DOCK
4 -
Tillable 3
Woodland
SwonVlw-.d
7-
Brushland
House Plot
Total
M. B Idg.
Foundation
Both
-
Extension-_
tf <, t
Basement
Floors
+
Extension
0 0
Ext. Walls
Interior Finish
F-xtension
Fire Place
Heat
C-,
Porch
Roof Type
Porch
Rooms I st Floor
8reezeway
Pat—
Rooms 2nd Floor
Garage
Driveway
Dor mer
B.
STATE OF NEW YORK:
. ss.
COUNTY OF SUFFOLK:
RALPH E. LAVINIA and ANNA L. LAVINIA, being duly sworn,
deposes and says:
That we are the owners of a parcel of land on a private road
off South Harbor Road, Southold, New York (Suffolk County Tax Map
No. District 1000, Section 87, Block 1, Lot 15). We acquired
this parcel on September 21, 1964 from Mary M. Kilhofer (Liber
5622 Page 581).
Located on the property is a one-story frame house which has
been used continuously as a residence since approximately 1948.
Also located on the premises is a separate shed. All of the
buildings are in good condition and have been constructed prior
to 1957.
This application is made for the purpose of obtaining a
pre-existing Certificate of Occupancy from the Building Department
of the Town of Southold.
Sworn to before me this
Loth day of September, 1982.
er'
Ralph E. Lavini"
A0 3c/ ,
Anna L. Lavinia
BARBARA DIACHUN
Notary Public, State of New York
No. 52.4635190 Suffolk
rAMMWWM f xP m March 3% 19gq
Location
BUILDIITG DEPARTNE1,1T
TOVM OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Subdivision i"iap No. Lot(s)
Name of 0%•mer(s)
Occupancy, a— %
{type owner tenant
Admitted by: Accompanied by:�� 4
Key available
Suffolk Co. Tax No. -97. 1 -15 -
Source of - j
'01 Date
DWELLING:
Type of construction
Foundation
< #s-tories- g?j.�7
Cellar i����--Crawl spaceL��
Total rooms, 1st. Fl4-- 2nd. Fl 3rd. F1
Bathrooms) Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat 'rlarm Air 11� Hotwater
Fireplace(s) No. Exits Airconditio_ning
Domestic hotwater Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Remarks:
Inspected by: Date of Insp. !l
Time start end q
In