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Home My WebLink AboutZ-11245FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 2.1,1245.......... Date ...... October. 7 . . ..............1 19 .82 .. THIS CERTIFIES that the building 9... ?)........................................ . Location of Property .. 101 5 . Private Rd . #9 --Ford s Rd. Southold House No. Street . . . . . . . .Hamlet County Tax Map No. 1000 Section .... 90.7. .... Block . 01 ...........Lot ... Q 17.......... . Subdivision ....X ..........................Filed Map No. ..X .....Lot No. ... X ........ Requirements for a private one -family dwelling built prior to conforms substantially to the Al>ntization-for�ttiidmg�Permit-iteretoPore-fiied'in-iiiis'effice'date� Certificate of Occupancy A.pri1. 23 ......... 19 5.7 pursuant to which Buiitiing"rfnlrNo. .21 1245 ...... . ..... . dated......October..7 ....... 19 82. , 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 private one -family dwelling with accessory storage building. ................................................................................ The certificate is issued to ......... Ral. L. Lavinia ...ph...E......Anna ..................................... (owner, lemevrterra & of the aforesaid building. Suffolk County Department of Health Approval ...... n/a ................................ UNDERWRITERS CERTIFICATE NO .............. n/a ................................ Building Inspector 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 , ,September 1 4, 1982 New Building ............. Old or Pre-existing Building .. X ........ Vacant Land ............. Location of Property Private Road . (Off South Harbor load), ,,,, , , , , , , , , , Southold, , , , . .. .... ... ... . . ... ....... House No. Street Hamlet Owner or Owners of Property .. , .Ralph La..vinia and.Anna ..Lavinia. .................... ........................ County Tax Map No. 1000 Section ....87......... Block ....1.......... Lot ...1?l0 ,17, , , , , 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 meets all apppplicable codes regulations. RAS-' CO`/�-- Applicant . G�• . .. ` 5 : . C .............. Ralph L v' is Rev. 10-10a8 Qpn 2077(0 na Lavinia STATE OF NEW YORK: ss. COUNTY OF SUFFOLK: RALPH LAVINIA and ANNA LAVINIA, being duly sworn, deposes land says: That we are the owners of a parcel of land on a private road j'off South Harbor Road, Southold, New York (Suffolk County Tax Map . District 1000, Section 87, Block 1, Lot P/O 17). We acquired this parcel on March 7, 1968 from Edward H. Ford (Liber 6315 Page 461). Located on the property is a one-story frame house and an attached garage which has been used continuously as a residence since 1948. Also located on the premises are a separate garage and a shed. All of the buildings are in good condition and have constructed prior to 1957. The application is made for the purpose of obtaining a isting Certificate of Occupancy from the Building Department f the Town of Southold. Sworn to before me this 14th day of September, 1982. BARBARA DIACHUN Notofy public, State of New Yo* No. 52,4635190 Suffolk Com"11V Commission Expires March 30, 19 d -I WNER STREET VILLAGE DISTRICT SUB. LOT tz ORMtR OWNER r N ACREAGE fn C S TYPE OF BtJI two .S. SEAS. comm. I -N D. CB. misc. I LAND IMP. TOTAL DATE REMARKS 0 -4414 It n 1(4 #00 17 1 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Form i Acre Value Per Acre Value ible I ble 2 1-6 6 0 ble 3 all iinnd 0 ! T" Cc - N fo M. Bldg. Foundation Both Extension Basement Floors i�W Extension 1-2 a Ext Walls V, i Interior Finish Extension >( Fire Place Heat A 2 7 J 7 Porch — —,--r—oms Attic PorchR 1st Floor oOMs I Breezeway Patio Rooms 2nd Floor Garage'2 -t Driveway 41 kul Location Subdivision BUILDINIG DEPARTMENT TORN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT I number & street&� Muni Name of Own er(s) Occupancy c ip Yap No. Lot(s) r 4 (typ e) owner enant Admitted by: ' %-.fL �� ,� Accompanied by: ,2,e!,2 Key available ' Suffolk Co. Tax No. Source of request „L.Date MTP T.T.T,\Tr- Type of construction#s tories Foundation;d Cellarz��* Crawl space Total rooms, lst. Fl 21-d. Fl 3rd. Fl Bathroom(s) qToilet room(s) / Aa a targe r g le ..e Deck, type Patio ioJ type Breezeway_Garagedii� U� roo Type Heat ',farm Air Hotwater Fireplace(s) No. Exits Airconditioning Domestic hotwater ®, Tvn,A %-- /!l Other ACCESSORY STRUCTURES: Garage, type const. Storage, type ype const. -W//��/ SWimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 Remarks: Inspected by: 07 fZ Date of Insp. Time start._q� end q t M