HomeMy WebLinkAboutZ-10318FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
'~ 10~18
No. ~
Date .... ~.o.q ~m. '.~ ?.r..
THIS CERTIFIES that the building ................................................
1000 Old Harbor Road, New Suffolk, N.Y.
Location of Property ...............................................................
House No. Street Ham/et
County Tax Map No. 1000 Section .... q ~..7 ..... Block ....0.~ ......... Lot...'1.0.: ? ?..&.. ? .2...
Subdivision ............................... Filed Map No ......... Lot No ..............
Reouirements for a One F~.ial!y i~::e:Lllng Built Pr£or to
conforms substanti~ly to the ~p~em4~g~~Wh~.~e4~~o~~-
C,e~f.~a~ of .Occupancy
.... ¢.?.~5. ~>., ....... , ~9. ?Tpur~uant to ~:. ,~~~-. ........ Z~O~X~ .....
dated ...~.e. ~.e.m.~.o..~. ?_.~. ~. ...........19..8.0, 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 . .QBe ....
.~m..t.ly...t¢::9.~.1.],..rig' .~.~..~.h..499.e.~.~.9 .vT..S.~..m.q~?. r?.(9~, r.,.~. )...~.t.~.h.. 9.u.~.~..t. ~o.o..~..~d
Toilet Room.
The certificate is issued toHarold F. 8nd Jone V. Lundine
..................... io¥.'o'r, ~¢'~:~'~it~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval ....N/.R. ...................................
UNDERWRITERS CERTIFICATE NO .... .I~/.R. ..........................................
Building Inspector
Rev 4/79
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.
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
New Building ............. Old or Pre-existing Build~.ng . ~ ......... Vacant Land .............
Location of Property ......................... O3d. Har];)o3; .Ro~d ..... ~'~ew..SuEffcxlk .....
House No. Street Ham/et
Owner or Owners of Property . .H~C. Qld. ;~-3d. J~3_ne. Lu~zd±n.e, ..............................
County Tax Map No. 1000 Section ...317 ......... Block ... -~ .......... Lot. 3,Q,. 3-3- .&. ;]2..
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant . ~.a.z;o..~..;~z~]. ~.~. ~4q~£~ .....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... ~ .................
Fee Submitted $. ~, .0.q .......................
Construction on above described building a~e/e~ts ~app~~ and regu lations.
Applicant..~.~.~.~~/~....L~/.~.~~ ~/~/'/~'~ ~'~ .............
~/A~31-d & J/~ne L~undin~/ by Rudol~sh PI. Bruer, d
Rev. 10-10-78 "' I f/ Attor.~y ~ I 0
BUILDING DEPARTMENT
T0~'~: OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 1000 01d Harbor Road. New Suffo]k
(number & street)
Subdivision Map No.
(Municipality)
Lot(s)
N~me of 0vrner(s) Harold F. & Jane V. Lundin~
Occupancy R-1
(type)
Admitted by: Mrs. Edson
Unoccupied
(owner'ten~t)
Accompanied by: Mrs. Edson
Key available
Suffolk Co. Tax No.!17-05-10'11-12
Source of request Rudolph H. Bruer
Date Dec. 22, 1980
DWI~LING:
Type of construction Wood
Foundatic~ement Block
Total rooms, 1st. F1 3
Bathroom(s) 1
Porch, type glassed in
Breezeway.
Type Heat electric
Fireplace(s)
Domestic hotwater Yes
#stories
ee~ar Slab Crawl space
2nd. F1 3 3rd. FI
Toilet room(s)
Deck, type open
Garag~
Warm Air X
No. Exits 3
Type heater
Patio, type slate
Utility room
Hotwater
Airconditionin~
Electric
Other
ACCESSORY STRUCTURES:
Oarage, type const. Storage, type const.
Swimming pool GUest, type const.
Other One Car Garage with Guest Room an Toilet Room
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
No Violations of Housing Code, CH52 where ..
found ......
Remarks:
Curtis Horton
Date of Insp. Dec. 23, 1980
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