HomeMy WebLinkAboutZ-9271FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
Z9271
No ............. Date .... .O?.t.°..kc.r- ·..
_.220~:) Main Road
THIS CERTIFIES that the building located ~ ............................
conforms substantially to th CY
dated April 23 1~.7. pursuant to which~No. Z9271
October 27 1978
dated ....................... , .... , was issued, and conforms to all of the req,,ire.
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is Private One F~mily Dwelling
The certificate is issued to Glenn E. Moon & wf.
(owner, ~t )
of the aforesaid building.
Suffolk County Department of Health Approval .......... .N./.R../ .....................
UNDERWRITERS CERTIFICATE No. N/R/
HOUSE NUMBER 220/~0 Street Main Road
' Orient, N.Y.
Building Inspector
HOUSING CODE INSPECTION
October 27, 1978
22040 Main Road
Orient, N.Y.
Tax Roll:
occupied:
Glenn E. & W. Moon
Upon receipt of an application for a Pre-Existing Certificate of
Occupancy, I made an inspection of the dwelling on this premises~ I
began this inspection at approximately 9:00 A.M. with Mr. & Mrs.
Moon.
Located on this property is a two story, wood framed dwelling, no
other buildings are on this property.
This dwelling has a full cellar. The foundation walls are constructed
of brick, outside entrance only. Located in the cellar is the electric
panel, water pump and tank, and oi% fired steam boiler, which provides
the heat for this dwelling.
First floor consists of a very large front porch, large living
room with fireplace, dining room, kitchen with a large pantry, which
has a washer, dryer and freezer in it, there is also a full bathroom.
Second floor consists of three large bedrooms and a full bathroom.
There is also two stairways leading upstairs.
The outside of this dwelling is in very good shape.
No violations of the Housing Code, Chapter 52, Code of the Town
of Southold, N.Y. were found.
Inspection completed at approximately 9:45 A.M.
Respectfully submitted,
CURTIS HORTON
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
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 triplicate 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
3. Copy of certificate of occupancy $1.00
$5.00
Date (~ C_-'['.
New Building .................... Old or Pre-existing Building ........ Z ............. Vacant Land ...~ ........................
Locat,on of Prope
Owner Or Owners Of Property /_~ ~'/~l~ ....~..~ M(~ O A/ ..~....A/.~. Y
Subdivision ................................................................ Lot No ............. Block No ............. House No.~.,~.~..4/d-~
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 $ .... ~....~....~.. ...................
Sworn to before me this
................ day of ............................................ (stamp or seal)
Notary Public .................................... County ~ ~06/~ C~z,~, ~/;X /u_~