HomeMy WebLinkAboutZ-11253FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. .......... Date ......October 13 ..............1 1982.
THIS CERTIFIES that the building e... i? ) ..........................................
Location of Property..?95.............. Town_ Creek Lane ... Southold
House No. Street Hamlet
County Tax Map No. 1000 Section ..064 ....... Block . Q 1 ...........Lot . 006, ......... .
Subdivision ..... X.........................Filed Map No. ..X .....Lot No. . X...........
Requirements for a private one -family dwelling built prior to
conforms substantially to the A.riplicatiori.fos_hefet& � .iii-tkis-offieedated-
Certificate of Occupancy
APril..23........ 19 5.7. pursuant to which Buildin-PrrnritNo. .. X 1 1253, ......... .
dated .......October 13 ......... 19 82 , 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 .........
a private one -family d>relling and one accessory storage building.
.......................................
The certificate is issued to ........Roger! .McCarvill
.................................
(owner, leseeeer�teti►enti
of the aforesaid building.
Suffolk County Department of Health Approval .... r. a............................ .......
UNDERWRITERS CERTIFICATE NO............ n/a.................................. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Building Inspector
Rev. 1/81
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
Nev., Building ............. Old or Pre-existing Building(X) . _- _ s Vacant Land p
Location of Property ..... �. . . _ ... l .:L�_I, itr..' . .. �T�....... House No. e Hamlet
/
Owner or Owners of Property t?�2��.-�, , , , , , ,l,�Ci4�.`�1.
County Tax Map No: 1000 Section .... Block ....... Lot .. . (a.......
Subdivision .........x ......................Filed Map No. ..K ........ Lot No. ..A....... G
Permit No. ...�-:.... Date of Permit ........Applicant ....... ......................... . CiA_
Health Dept. Approval ......X .................Labor Dept. Approval ..... y. ............. .
Underwriters Approval ...... Y................Planning Board Approval ....1� . .
Request for Temporary Certificate ............... .... Final Certificate ......�........ -
S4S
Fee Submitted $ ... S. ..... ............. .. .
Construction on above described building an ermirme cable c and regu ti
Applicant
Rev. 10-10.78 � �. 00 jcu_ G y r ecj Av-e
5o_�04
0. 1 (Q S73
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
number & street Municipality
Subdivision_ Map No. Lots)
Name of Owner(s)
0 c cup ancy_
--- tlroc
e)// towner-tenan
Admitted by:_ Accompanied by:
Key available �� Suffolk Co. Tax No.
Source of request �' �"'�� Date-
DWELLING-
Type
ate
DWELLING°Type of construction/�� -�
#stories_
Foundation W41asr6V 1- Cellar Crawl space
Totalrooms, lst. F1 2nd. F1 3rd. F1
Bathroom(s) Toilet room(s)
Porch, type_ Deck, type e, Patio, type _
Breezeway. Garage Utility room
Type Heat Warm Air Hotwater a
Fireplace(s) No. Exits_Airconditioning
Domestic hot-water Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const.__
Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location
Description,
Art.
Sec.
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Remarks:rL,/► 2 A7V0Ci� i
+n.!
Inspected by:
Date of Insp. 0
Time start end I Y Y�