HomeMy WebLinkAboutZ-11012No.. Z.1.1012.. .
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date .......May. 27.. ................. 19 82
THIS CERTIFIES that the building a ...(.2 ) ............................................
55 Fequash Ave.
Location of Pybperty ..3010.0 .............. Maln . Roa.................. C
d ..utcho$ue
House No. Street Ham/et
County Tax Map No. 1000 Section .1.02 ........ Block .. Q3 ..........Lot .. QQ7.......... .
Subdivision ...X ...........................Filed Map No. X. ...... Lot No. X............
Requirements for a private one -family dwelling built prior to
conforms substantially to the e�.atioal. fas$uiisiirig.P.esmitayesekofo�.��laC(_;p_ttcf�iC�dad
Certificate of Occupancy
April .23 ............. 19 5.7 pursuant to which B414ing4telmrri+No. .2110.1.2 .............
dated ..... May. 2.7 ................ 19 $2 , 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.ivat.e .ons. -family. dw.allirig .wi.th .acc.essory.. two. -.car. 94r 4&Q .
The certificate is issued to
(owner, /Qssea ar_Wn 4
of the aforesaid building.
Suffolk County Department of Health Approval....nir...................................
UNDERWRITERS CERTIFICATE NO ............ nlr.................................. .
.... .
Building Inspector
Rev. 1/81
FORM NO- G
10WN UI SOU 1 U01_U
Building Department
Town I Ldl
Southold. N.Y. 119/1
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 .... 5.. �.�.�"......... .
New Building ............. Old or Pre-existing Building ......j".... Vacant Land .............
(� 30 I 00 ss— h
Location of Property f •'•'• �" . • • •`�• � ti Sr ee� �.� �..
..
House No. ^^
Owner or Owners of Property I. .!� � ...... k� (Q l �
n OZ 0 -^�
County Tax Map No. 1000 Section ..� .....�.- ., ..... Block____.1........... "Lo60t ... (.:.��..... .
Subdivision ... i.� ............................Map No ........ (K...... Lot No. .)�............
Permit No. .......... Date of Permit ..........Applicant ..................................
Health Dept. Approval ........................Labor Dept. Approval ........................�
Underwriters Approval ........................Planning Board Approval ......................
Request for Temporary Certificate ..................... r al certificate ... ..................
.F D
Fee Submitted $ ...r. .....................
Construction on above described building and permi ets a i�ble c esand regulations.
`J O ht�l MOI�IZ��u/�t Applicant ... .. ..... .... ................ .
Rev. 10-10-7$
GA FLANNER OLSEN ESQ.
P. O. Box 38
%C 0 ° s/.2-) ftz_ Main Road
as Mattituck, L. L, MY. 11952
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE
d /o c) A,/ap- 7
Location 65—
number & st eet
Subdivision
Name of 0
Occupancy
Admitted
Key avail
INSPECTION REPORT
eo -vd
G1 X7d
C Tom,
Municipal
Map No. — Lot(s)
?'C /67-1)-7
Source of requestDate i
DWELLING:
Type of construction ��W #stories --7"w,)
Foundation CeY,--"ez,7Z Zlar_k Cellar _Crawl space
Total rooms, lst. F _2nd. F1 3 rat S 3rd. F1
Hcl S
Zzthroom(s) Z Toilet room(s)
0 � /
Porch, Deck, type -- Patio, type --
Breezeway Garage Utility room
Type Heat2c�—a-'A' ` Warm Air mer 57--L—<z-?i _Or�114
Fireplace(s) No. Exits —7 W o Airconditioning
Domestic hotwat er 2±-- Type heater
Other
ACCESSORY STRUCTURES: U.I/F
Garage, type const.-7;k/c) CSr'r Storage, type const. —
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location
Description 1LArtA.
Sec.—
Pm
IN
W111,11111 0!
Remarks:
Inspected by:
� v
Date of Insp. '5-2
Time startal odd, ��