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Home My WebLink AboutZ-5229FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.::5?,?9....... Date June...27.., 19.73. THIS CERTIFIES that the building located at .. New. S.uf folk. Road ...... Street Map No. . XX ........ Block No. ..XX...... Lot No. . X.X .. N e -v . Suf f Ilk ................... conforms substantially to ther me f o !tt d�l�[Ig_i L'ouiin¢ code Built before April 23 a ificate of occurancy dated ....................... 19.57. pursuant to whichN�;3iTTo. 2..5229. dated ....... June ..... 27- . • , 19. 7-3, 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 .. Pr- iva-te . one .family. dwelling ...................................... The certificate is issued to .. Jacob.. kllynarezk....... Ywner..................... . of the aforesaid building. (owner, lessee or tenant) Suffolk County Department of Health Approval Fre-existing ................... UNDERWRITERS CERTIFICATE No.. pre-. e.XjStjAg HOUSE NUMBER ... 6750 ..... Street.....New. ;�;uf folk .34ad. . ...................... . Building Inspector Pre-C.O. - H.C. Inspection January 27, 1973 Jacob Mlynarczk 6750 New Suffolk Road New Suffolk, N. Y. Mr. and Mrs. Buhler admitted me about 11:30 A.M. The ceilings on the first floor are 715"/ It is a story and a half with 7'2" on the second floor, which has a bath and two bedrooms. There is one Base plug in each bedroom. I noticed no violations. The yard and house are in good condition. There is an attached garage and two minor accessory buildings (see survey). At 11:40 A.M. I completed the inspection. George Fisher, Bldg. Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 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 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 Date................................................ New Building .................... Old or Pre-existing Building ....... X.............. Vacant Land ............................ 675o 15 ..s f �.1( Td..... f../1/ r. S ..f. fd./.....1C.. Location Of Property ......... .... .... „^ .......... .......... Owner Or Owners Of Property .... Qm.Ga..6........ / �. �.. �..y..&.0"m.......4r .Z-... Subdivision .......�..%%...aa..............N. .......................Lot No............. Block No............. House No..6.7.5 o Permit No......./.!.. ...... Date Of Permit ..10t .....Applicant...................................................................: Health Dept. Approval...........,N.�,,,�//......��................Labor Dept. Approval ........411 ........................... Underwriters Approval................../.�.1h...............Planning Board Approval ..... <V.,.//..................... Request For Te rary Certificate ............... Alll�.......... Final Certificate..........Y........................... 0 Fee Submitted e.._.r�o ..................... Construction on above described building and permit2s.-_�Il pI'cob co a re ulations. 9Applicant ................},.. 0.... ... ... ...,. ..... .,............ Sworn to _!�Pfore me this r .. .... day of . ,(.//................. (stamp or seal) Notary Public .... .C(" ........F...i.1 ..... County c LEFFERTS PAINE EDSON NOTARY PUBLIC, Stafe of Now York No. 52-1077685 . Suffolk Counfy Commission Expires March 30, 1976 tic Dl— I- b Nr L I.JE. V \V%ll i ! 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