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HomeMy WebLinkAboutZ-9631FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy 29671 AUGUnm 13 19 79 No.................. Date .... ............................, THIS CERTIFIES that the building ................................................ 11115 Main Bayview Road Southold Location of Property .. ....................... . House No. Street Hamlet County Tax Map No. 1000 Section ...... ......Block ...............Lot .... 7........... . Subdivision ...............................Filed Map No. ........Lot No. ............. ,e uirements for a one family dwellin built prior to conforms substantially to the Certificate of Occupanc ... APF... .� ......... 1195.7. . ...... X9631...... . dated .. AUGUST .13 .... 19 79 , 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. ,q . . one _family dwelling w/ 4 accessory buildinvs The certificate is issued to FIi{Q? IP J. , JR.. and SFiARYi�? OFR . ..... . ........... . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ N/R UNDERWRITERS CERTIFICATE NO ................ ... ./ ........... Rev 4/79 FORM NO. 6 TOWN OF SOUTHOLD G 5 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 J�—�P— Date .. 7 ......... New Building ............. Old or Pre-existing Building ........ Vacant Land ............. Location of Property . i6. .L11C—� .... 1.�E?!9 �......... SCo .. %/gyp �:.�......... .... . House N Street Hamlet Owner or Owners of Property .�.I. .J ���... .'....-3. .... 5�.�:''.,Y.! ..d� County Tax Map No. 1000 Section .. © ..... Block ........ ....... Lot ................ Subdivision .................................Filed Map No. ..........Lot No. ............. Permit No. .......... Date of Permit ..........Applicant .................................. HealthDept. Approval ........................Labor Dept. Approval ........................ Underwriters Approval ........................Planning Board Approval ....................... Request for Temporary Certificate .....................Final Certificate ....................... Fee Submitted $ .............................�� Construction on above described building bpd-g*Kt mgets alb Wlicable codes.and regulations. Applicant ........ ... Rev. 10-10-78 .>/Go 7 Location //// Subdivision Name of Owner(s) Occupancy /C- BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT er & street T— c Map No. Lot(s) (type) Admitted by: /r-fe5 ��/Z�/1 Accompanied /F1I0Z owner - by: -5i0/Vc Key available Suffolk Co. Tax No.loo6 -0 )/-007 Source of request 0�w-lZ/C Date "41jr,- /a 7 9 T)WPT.T.TTT1 Type of construction � i E #stories /Z Foundation} f ellar� Crawl space /Girt Total rooms, 1st. F]Z/X 2nd. F11,6 S 3rd. Fl e e/Z-S Bathroom(s) ThrEE ZA:V - Toilet room(s) Porch, types/pE jFW&; Deck, type — Patio, type Breezeway GarageCgepir-7-- Utility room Type Heat 'farm Air Hotwater Fireplace Exits Airconditioning Domestic hotwater y� Type heaterl2�/7 Other ACCESSORY STRUCTURES : `wa .:5�6r1X2j Garage, t ,Q g , ype const. apoy FFr,,j"F Storage, type const � r Swimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 . . Description- 11171A Ire, owl "24WA NPOW i PAIWTIMAW14_ Ill Remarks: Inspected .4'�i. �. /�� /, , ��.�ate of Insp. 4 / Time starn • .I •Z. Z. 3-3.