HomeMy WebLinkAboutZ-10396FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No... Z.1.Q39E:........ Date .... Fe.t.vLiarY..c3.,..............I im...
THIS CERTIFIES that the building ................................................
Location of Property House No `i 0 -0 aup i in -e o 1 a• o a Street iyl a.t. t' i t i -0k ='S • It Helm%et
County Tax Map No. 1000 Section .... 1.2:3 ..... Block ......5 ........Lot ....1.9 ...........
Subdivision .......... ...................Filed Map No. ........Lot No. ..............
requirements for a. One -Family Dwelling Built Prior t
conforms substantially to the-YApplkat-iera- Pear t-h&rete ore4®cl- r-tis-owlee da"--
...... A.prJ § ..... , 19 7. pursuant to which, e of cater of Occupancy
..r4 .
dated ...... F::.hr.-i? ar.y..23.1 ........ 19G I. , 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.riva.te iwalling . J;ith. A,acess.ory. Dae. C.Sr. Gar.age. atruc.ture
The certificate is issued to • ... • . .. • • . •
(owner, ksse&o*e
xnantl-----
of the aforesaid building.
Suffolk County Department of Health Approval .... ix / R ................. . .
UNDERWRITERS CERTIFICATE NO.... N/a..........................................
Building Inspector
Rev. 1/81
BUILDING DEPAPMIENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location_ 3950 Camp Mineola RN.Y.
number & street) Municipalit
Subdivision Map No. Lot(s)
Name of Own er(s) Ann Patricia Murphy
Occupancy R-1
type owner -tenant
Admitted by: Self Accompanied by:qolf
Cutchoggue
Key available First Towne Real tySuffolk Co. Tax No. 123-5-19
Source of request Gary Flanner Olsen
DWELLING:
Date 2/11/81
Type of construction Wood #,Estories One
Foundation Cement Block Cellar Crawl space Y
Total rooms, 1st. Fl 6 2nd. F1 3rd. Fl
Bathrocm(s) 2 Toilet room(s)
Parch, type Deck, type Patio, type
Breezeway Garage Utility room x
Type Heat oil Fired 'alarm Air Y Hotwater
Fireplace(s) 1 No. Exits 2 Airconditioning
-Domestic hotwat?r Yes Type heater _Rjectrin
Other
ACCESSORY STRUCTURES:
Garage, type const. wood 1 Car Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Remarks:
Inspected by: ("_4h „ 1,iy�Dato of Insp. 2/19/81
Curtis Horton Time start 2:30 end 3:00
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.
B. 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.
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 .. ^'\� x �., ............
New Building ............. Old or Pre-existing Building .......... Vacant Land .............
Location of Property ......... CP 'tt'k... \ 1..'.:.': ;`�. >1 v� `'1,�, , ....... .
House No. �i Street Ham/et
Owner or Owners of Property `r\`��. �.�!�,4�\�.Vo
. .. h \A N JV 1
County Tax Map No. 1000 Section ..... t>........ Block ............... Lot .. \ ......... .
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 .................
Fee Submitted $ . /
Construction on above described building and p
Applicant . f
Rev. 10-10.78
Certificate .....?i., ...............
r t ee SII- pplica des and regulati s.
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