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Home My WebLink AboutZ-9354NO. 4 TOWN OF $OUTHOLB BUILDING DEPARTMENT Town Clerk% Office Southold, N. Y. Certificete Of Occupancy No...Z..9:~.~.~. .... Date .. D.e..c.e.m?..e.r...2.2. ........... , 19..7.8. R.0.W. off THIS CERTIFIES that the building located at . Momtauk-A¥.e ............. Street Map No ............. Block No ........... Lot No .................................. REQUIREMENT~ FOR ONE FAMILY DWi,LING BUILT PRIOR TO confoi:ins substantially to the ~&l~a~i~-.- s~d'A.;l~tk~g~l~& I~,~.~,., CERTIFICATE OF OCCUPANCY dated . .A.p.~.i. 1...2.~. ........... , 19.5..7. pursuant to which ~t No. dated . .D.e.c..e~l..b.e.r....2.2 ........ , 19..7.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... .P.r..iy.a.t.e...OD.e.. F.aM..i.l.y' . .D~..e.ll..i.nE ................................... The certificate is issued to ..... .R.o.s..e..Iv!e..d.e?.~' ..................................... (owner,~ of the aforesaid building. Suffolk County Department of Health Approval Pre-Existing UNDERWRITERS CERTIFICATE No .................... P.r..e.-..E~.i..s.t.i.n..g./ .......... HA. .......... R.0.W .... off'~iontauk Ave / vuo-. lq uivu~,,l~ .............. ~zreez ........ :-~; .............. .~/ ............. .......................................... / BuildiniI Inspector Count~ Tax ~,mber 1000-10-8-3 Location Subdivision R.0.W. (number & street) BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT off Montauk Ave Map No. Fishers Island (Municipality) Lot(s) Nsme of Owner(s) Rose Medert Occupancy R-1 (type) Admitted by: (owner-tenant) Accompanied by: Tenant Key available Suffolk Co. Tax No. 1000-10-8-3 Source of request appl. Robert TaSker Date 12/19/78 DWELLING: Type of construction Foundation Total rooms, 1st. F1 Bathroom(s) Porch, type Breezeway Type Heat Fireplace(s) Domestic hotwater Other ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other #sTories Cellar Crawl space 2nd. FI 3rd. FI Toilet room(s) Deck, type Garage Warm Air No. Exits Patio, type__ Utility room Hotwater Airconditionin~ Type heater Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. No inspection made, verified by Serge Doyen per phone conversation. Remarks: per Serge Doyen, house in good order & has heat verified Inspected by: Date ~. 12/21/78 Time start end FORM NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office 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 Inspector 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 sdpply 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 installations, 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 property 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 in- formation 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 New Bt~ilding ................ Addition ................ Old or Pre-existing Building .......,.~.. ..... Vacant Land .............. Location Of Property Private rights of ways lying to the north of Alpine Avenue and west 6{"~6i~'~i~l~'~'d'~';'-FYg~'~'~ ~"I'~'~;"~i~'Y'~", ...................................... Owner Or Owners Of Property ~.~.~.~.e.~.e.~.e.~?~.~.?~.~.~.S..q.n..h.u.~.~...~..~...~.~.~..~.~.~~bi~ ................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ...... ~ ......................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .~.:.,0...0. .......................... Construction on dbove described building and ~e> all a~_ le codes and regulations. Applicant ..... '.....~..~.~....~...~ ...................................... Robert W. Tasker, Attorney for Owner Sworn 'o before me this ~.~'r'.f~ /6~/ ................ day of ............................................ (stamp or seal) Notary Public .................................... County ,:7!