HomeMy WebLinkAboutZ-9677FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Date ...S..eP.~.e.m.b. 9.r..~.? ................ 19 7.9.
THIS CERTIFIES that the building ................................................
170 Love Lane Street Mattituck
Location of Property fi3t;s~ ~/o~ ................................................... I:lDr;)ie~
County Ta× Map No. 1000 Section .... 1./3.0. ..... Block .... .~. ......... Lot .... .2. ...........
Subdivision .... Filed Map No ......... Lot No ..............
Requirements for a commercial building built prior to
conforms substantially to the
57 Certificate of Occupancy
April 25 19... pursuant to which ~ No ....... .Z9.6.7..7- .........
dated ...S..eP.~'e.~l~¢?..q. 7 ........... 197.9., 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 ......... Retail Store
M. A. Kelsey Properties, Inc.
The certificate is issued to ..................... /o'v~n~ '~'9 ........... '~ ..........
of the aforesaid building.
Suffolk County Department of Health Approval .............. .N./.R. ........................
UNDERWRITERS CERTIFICATE NO ...................... .N./.R. ........................
Building Inspector
Rev 4/79
Location
Subdivision --
Name of Owner(s)_
Occupancy ~- /
(type)
Admitted by:
Key available
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(number & street)
Map No.
(o~er-ten~t
Accomp~ied by:
(Municipality
Lot(s)
Suffolk Co. T~x
Source of request /~/J/C,'/~'/~ ~ //J/z':/C~'~7
Type of construction ~x~e~7 ~/~3C~ J~o~ W~. #stories
Foundation ~/~
1st. F1 ~7~
Total rooms,
Bathroom(s)
Porch, type
Breezeway
Type Heat ~ ~
Fireplace(s)
Deck,
Garage
Warm Air'~/~
No. Exits
Domestic hotwater
Other
Cellar-2~--~. Crawl
2nd. F1 3rd. F1
Toilet room(s)
type Patio, typq__
Utility room
Hotw~ater
Airconditioning
Type heater ~
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description
Art. Sec.
--~-' _~-~-m~_ ~.g.
Remarks: ~~Z
Inspected by ~
-Date of Insp. I g-7
Time start~:~'~end
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 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 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
New Building ............. Old or Pre-existing Building .... .X ....... Vacant Land .............
Location of Property 170 Love Lane Mattituck
House No. Street Hamlet
Owner or Owners of Prope~y M.A. Kelsey Properties, Inc.
County Tax Map No. 1000 Section 140 Block 3 Lot 2
Subdivision ................................. Map No ............... Lot No ...............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Tempo rary Certificate ..................... Final Certificate
Fee Submitted $ 5.00