HomeMy WebLinkAboutZ-9326FO~ NO. 4
TOWN OF SOUTHOLD
BU',DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z9526 Date December ~ 19. 78
THIS CERTIFIES that the building located at ./~.2. 0..L..al}..e..V.i. ?..T.e.~.?.a.c.e.,, ~
Map No ............. Block No ........... Lot No ..................................
REQU~S FOR ONE FAMILY DW~.T.ING BUILT PRIOR TO
conforms substantially to the l~t,~,g~.~~L~ ~.-~ ~d'-,,~ ~ .... -
CERTIFICATE OF OCCUPANCY
dated ..... .Ap?.i.l~ ..... 2..~ .... , 19..5.7. pursuant to which:~~t No..-Z9.526
dated . D. eo~l.b, er. ..... /~ ......, 19.18., 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 .......... .n,..~.v.,.~..,. 9~e...F..~.~¥. ~..%%~. ..............................
The certificate is issued to ......... .Z.d.a...Ba.~ .t;.~.e...1~..cD.o.n.n.]; .d .......................
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval ............ .Pr..e.-..E~..i.s.~..l~. g ..........
UNDERWRITERS CERTIFICATE No ..................... .P~..e.-..E~..i.s.~..i.n.g. .........
HOUSE NUMBER .., .~.2.0. ....... Street .............. .L..a.~..e..V.i..e~...T.e..r~..s.c..e .......
B~filding Inspector
County Tax N,~ber
1000-0151-9-11
Location
Subdivis ion
Name of Owner(s)
Occupancy
Admitted by:
Key available
Source of request
BUILDING DEPB/RTMENT
TOV~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
420 Lake View Terrace
(number & street)
Map No.
Ida Battle Mac Donald
R-1 Seasonal
(type)
Se] f
Ernest Radford
Irving L. Price Jr.
East Marion
(Municipality)
Lot(s)
Sum~e~
(owner-~
Accompanied by:
Suffolk Co. Tax No. 1000-031-9-11
Date 11-30-78
DW~LLING:
Type of construction
Foundation wood posts
Total rooms, 1st. F1 ~
Bathroom(s) 1 sm~ll
Porch, type screened
Breezeway
Type Heat Oil fired
Fireplace(s)
Domestic hotwater
Other
ACCESSORY STRUCTURES:
Garage, type const. 2 car/wood
Swimmingpool
Other None
Wood framed #stories
Cellar Crawl space
2nd. F1 3rd. F1
Toilet room(s)
Deck, type
Garage
Warm Air
No. Exits
X Type heater
Patio, type
Utility room
Hotwater
2 Airconditioning
gas
Storage, type const.
Guest, type const.
X
X
X
VIOLATIONS:
Location
Front porch
Bathroom
Kitchen
Garage
Housing Code, Chapter 52
Descriotion .Art.
Porch screens need repairs III
Pipes poor condition, leaks in bath-
room V
No shut off -gas stove V
Loaded with termites III
Sec.
52-31 B
52-51-1
52-52-B 2
52-31 B
Remarks:
Inspected by: ~~~, ~~
CURTIS HORTON
Date of Insp._ 12£1-78
Time start 2:00 end
2:30 P.M.
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 featu res.
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 ...~/..". ~.~..'. ,~. ...........
New Building ............. Old or Pre-existing Building .... ~ ..... Vacant Land .............
Location of Property . .~?...~?M.~I .~.~... t' ~¢~ .... ~¢~'r '~¢~' · .~1¢~ ~" ....
Hou~ No. St~et Ham/et
Owner or Owners of Property . ~.~~... ~4¢. ~~ ........................
County Tax Map No. 1000 Section .. ~1~.;~,~. ........ Block ...~. .......... Lot.., ./.~. ..........
Subdivision ............. .~. ,.~/..¢'. ............. Map No ............... Lot No ...............
Permit No .... .'T. ..... Date of Permit .......... Applicant ..... .-T. ...........................
Health Dept. Approval ............ .-- ........... Labor Dept. Approval ....... -'7. ................
Underwriters Approval ........................ Planning Board Approval
Request for Temporary Certificate ---- Final Certificate -"
Fee Submitted $ ..... . .~'~'~ .~. .................
Construction on above described building and ~ 9rmit meets all
Applicant.
Rev. 10-10-78
:ets all apj;;~icable