HomeMy WebLinkAboutZ-10286FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Z ~0286
NO ..................
December 5, 80
Date ................................ , 19...
THIS CERTIFIES that the buildh]g ................................................
Location of Property .. ?./*.8.0...N.~.8.~.U...P.O.~.~?..R.O. 8..d., ............ ?.U.~.o.b.O.g~..e' ...........
House No. ~ ~ 8 Stre~g 007 Hamlet
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision..N..8.~?.~.~...P.~....0..1.u.b..P.r..op.. ..... Filed Map No ......... Lot No.
Requirements for a One F_amil¥ Dwellin$ _Built _Prior_to
conforms substantially to the K'p-piS~SfftTo'h-f'o't"WJlTdTn~-P'eTr~T[ lge-fe~Td'r~T~gd-Tri TI~' ortTc~ h'%t'e-d- --
Certificate of Occupancy Z10286
· ~.p.r.i..1.._2.~ ~. ......... , 19 .~.7. pursuant to w'taetr1~~tt-Ntrr.-. ........ -:. ..........
dated ...D.e.q .e.m.b.e.r...5, ............. 19 .8.0. , was issued, and conforms to all orthe requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
One Family Dwelling with Accessory Structure which includes t~o car
Garage and Non-Conforming Living Unit to be used for Guest Occupancy
The certificate is issued to ....W.8~..~.e.l~.. H.'..If.ey.e?.~.o..h...8~.d..A.n.o.: ........................
(owner, I~ae. OI.~
of the aforesaid building.
Suffolk CountY Department of Health Approval .... N/.R ...................................
UNDERWRITERS CERTIFICATE NO .... .N/.R ..........................................
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 featu res.
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 unusual natural or
topographic featu res.
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
$5.00
Date . December. 2.,. ~LgBD .........
New Building ............. Old or Pre-existing Building ... ~( ........ Vacant Land .............
Location of Property . Nc-~$at~. Pp~rd;. R{;3~. ~. Ct]~-~]~ ....................................
House No. Street Ham/et
Owner or Owners of Property Walden H. I_eve. rich ~ Peter C. Leverich
County Tax Map No. 1000 Section 118 Block 6 Lot 7
Subdivision ................................. Filed Map No..1.5.6. ...... Lot No. 91
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate X
Fee Submitted $...5...0.0 .......................
Construction on above described building and permit meets all applica_b, le codes and ~egulations.
pp ica ~: .......................................
I, qX. LDEN H. LEVEl{ICH ,/I
Rev. 10-10-78
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ?~0 /q/~~ /-~'~ ~'~
(number~~& stree~t)
Subdivision//~ ~ ~:,~3~ Map No.
(Municipality)
Lot(s) 9/
Name of Owner(s)
Occupancy
(type)/
Admitted by: _~//~,
Key available
(owner~ ~.~
Accompanied by:
Source of request
DWELLING:
Type of construction f~Yoo~ ~-~~
Foundat io~o~ ~~ Cellar ~-~
#storie~/~
Crawl space
Total rooms, 1st. Fi~ 2nd. F1 3 ~D 3rd. Fi~LL_~Z~
Bathroom(s) om~ ~--~£~ Toilet room(s) .....
Porch, type~~c~. Deck, type ~Y~O00 Patio, typq__
Breezeway -~- Garage Utility room
Type Heat~/g~ Warm Air ~c ~/~ Hotwater ,
Fireplace(s) o~'~ No. Exits ~ Airconditionin~
Domestic hotwater ~ ~ype heater~>~ ~,~
Other
ACCESSORY STRUCTURES: ~Uo, o~
Garage, type const. 77/~ ~/~ Storage, type const.
Swimming pool Guest, type const.
Other
VZOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Inspected by: ~~~f~ '~ "
Date of Insp.~.
Time start/r~/~nd ~Q~ ~.~'
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