HomeMy WebLinkAboutZ-9835FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No... ?.. '..".' ......... Date ... Januam. t..17,..'t980 ........... 19...
THIS CERTIFIES that the building ................................................
Location of Property .... ./45.'Q.0.0,'I.~.. ~'~I~L?..Li~la?. .................. l~:.~J.~Cg. Ok,..l~l. ~r....
House No. Street Ham/et
County Tax Map No. 1000 Section . . fl.~.~ ...... Block .... 0.4 ......... Lot .... Q~.~ ..........
Subdivision ............................... Fried Map No ......... Lot No ..............
requirements for a one family dwelling built prior to
conforms subst_antially to the ............... - '
Certificate of Occupancy
....~p?.i.~...P_,~. ........ , 192.7. pursuant to which ~ ........... .Z9.8.~. ~ ....
dated .... ~..~.? ............ 1980., was issued, and conforms to aH o£the requirements
o£ the applicable provisions of the law. The occupancy £or which this certificate is issued is .........
.Pvl.v.a.l;~...~..P.a.m. ily...Dv~l!i~g ............................
The certificate is issued to ...... ~tiZli~m..E,. MJ,11er..& .wf. ...........................
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval ............ I~I/R ...........................
UNDERWRITERS CERTIFICATE NO .................... ~T,./.R ..... .../ ................
/
,
Building Inspector
Rev 4/79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location~-~O
(nl~mber & street)
Subdivision -
(Municipality)
Map No. -- Lot(s)
Name of Owner(s) ~/~/~ ~/~//~ ~
//
Occupancy /~-'/
( type ) ( own er - t ens~nt )
Admitted by: ~/~o/~F~f)~ Accompanied by:
Key available - - Suffolk Co. Tax
Source of request ~/~ ./~)X~,~OM Date /~./~
DWELLING:
Type of construction ~O~3~~,Q/~
C ell ar-'~,~-7 Z
Foundation ~/~C ~-~'/'OC,~-_ ~
/~C~ ~
Total rooms, let. FI~ ~ 2nd. F1 -- "
Bathroom(s)
Porch, type
Br e e z eway
Type Heat
Fireplace(s)
Domestic hotwater
Other
#stories ~/~_~
Crawl space ~
3rd. F1 --
Toilet room(s). --'
Deck, typ~ ~ Patio, typ~~-~-~
Garag~ ----- Utility room
'Warm Air~/~/~5~Hotwater
No. Exits ~ Airconditionin~ ~
Type heater ~/~--r7-~C~.
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
· Location Description Art. Sec.
Remarks: /
Inspected by: _~~Date of Insp. /./r~/~O
Time start/~:~ end ///6k~ YP'
Bo
Co
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 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 unusua~ 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 .. J~nuar.y.. 17,..1980 .....
New Building ............. Old or Pre-existing Building ..... ~ ...... Vacant Land .............
Location of Property .............. .O.b.e.. ~.q~..e..L.a.~.e. ................. H..a.~.~.~. t..u.c~. .........
House No. Street Ham/et
Owner or Owners of Property ..... ~.~.s, ....W.i.[.]:. J:..a.m. ?. .. . .N.~. ]:. ]:..e.~ .............................
County Tax Map No. 1000 Section ..... 122 ....... Block ........ 4 ...... Lot ........ 3:2 ......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant
Rev. 10-10-78 ~ tf~'l ' ~"l l I ~