HomeMy WebLinkAboutZ-10254FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No. Z1025h Date November I/4, 19 80
THIS CERTIFIES that the building S
Location of Property ...2.2..0..0..~1~...S.t.r..e.e.t., ................ .O.l:.e..e.12.p.o.~..~?..I~.: .~': .........
House No. Street Hamlet
County Tax Map No. 1000 Section ..... /4..2 .....Block ....... .'1 ....... Lot...2.~. ............
Subdivision ............................... Filed Map No ......... Lot No ..............
., r,equ, tr..emen~ts for a One-Family Dwelling built` pr~ior to
conforms substantially to tne ~p~t~o~r ~oi- l}mi~"i~g-taermi~-~e,m~.~-f~ed-~-ems-~n~e-ea~-
April 23, ....... ,19 57pursuant Certificate of Occupancy Z1025/4
................ to wl~l ~1I' 13 ffi~It'lq~. -. ....................
dated ...l~.o.¥.e~..b.e..~..'1.~.. ! ........... 19..8.0, 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 .........
.... .P.r.i.v.a..~.e..On. 9..-.F.a.m..t.ly' .D/q..e.l.1. $ .ng..w.i..t.h..Ac. 99.~.~.o..ry..O..ay.age... ................
The certificate is issued to ....H.e.n..r?. ?.....lvl.o.t:.8..ti..&...An..o.. ...............................
(owner, Ttneatar~~
of the aforesaid building.
Suffolk County Department of Health Approval . . .N./.R. ....................................
UNDERWRITERS CERTIFICATE NO...1~../.R ............................................
Building Inspector
Rev 4/79
Location 220 Oak Street,
(number & street)
Subdivision Map No.
Name of Owner(s) Henry F. Moisa & Ano.
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Greenport, N.Y.
(Municipality)
Lot(s),
Occupancy R- 1
(type)
Admitted by: Henry Moisa
Key available
Unoccupied
(owner-tenant)
Accompanied by: Henry Moisa
Suffolk Co. Tax No. 42-1-23
Source of request Henry Moisa
DateNOV. 13, 1980
DWELLING:
Type of construction Wood
Foundation Cement Block
Total rooms, 1st. F1
Bathroom(s) 1
Porch, type
Breezeway.
Type Heat 0il Fired
Fireplace(s)
Domestic hotwater
Other
Cellar Full
2nd. F1
Toilet room(s)
Deck, type
Garage
Warm Air
No. Exits
Yes
#stories One
Crawl space
3rd. F1
Patio, type
Utility room X
Hotwater X
Airconditionin~
TYPe heater Tankless
ACCESSORY STRUCTURES:
Garage, type const. Wood, One Ca~torage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Kitchen Gas Stove No Shut Off V 52,52-Bi
Remarks:
Inspected by: O~ ~-~/~7~ Date of Insp. Nov. 14, 1980
Curtis Horton Time start 9:20 end9:40
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 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 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
Date../'. Y~..~.. ('.~,.. .?. ~. .~. ~. ....
New Building ............. Old or Pre-existing Building ... ~ ...... Vacant Land .............
Property . .~./.~. ........................ ~.4~.~. .................. .~.~.~.~o/~/~ .~
Location
of
House No. Street Nam/et
Owner or Owners of Property ...~.~/4/~y../~'... ~'..~.~/r/'¢,.~..O~,./~}/~/~¢. .........................
County Tax Map No. 1000 Section .../-~..~r. ........ Block ... ~'. .......... Lot .~..~. ...........
Subdivision'~~.;~F.~.-~ · .~/~,-..~./.C4~.'· -~.~; .~-~ ....... Filed Map No. ¢~. ~./. ..... Lot ,o. ~ ~. .........
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate J
Fee Submitted $..~ .~.~/. ....................
Construction on above described building and permit meets all applicable codes and regulations.
Rev. 10-10-78