HomeMy WebLinkAboutZ-10720FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
'Certificate Of Occupancy
Z10720
No ..................
October 6 ]9--81.
Date ................................ ,
THIS CERTIFIES that the, building .......................... ' ......................
375 Grove Road
Location of Property .... 50..l!lll 1..C~.Oek..Dr'l.v.~., Armhamomaqtlo.,..~ouJ;kql~l~. ~{e~. X. ork
House No. Street Nam/et
CountY'Tax MaP No. i000 Section .... 1..3.5 ..... Block .... 0.3. ......... Lot... 9.6.7...h..6.8. ....
SubdMsion ' .Filed Map No. .Lot No ..............
Requirements for a One-Family Dwelling Built Prior to
conforms substautially to the AFl:rllt,'t~ow~t-B'trit~ =l?Petrtd't-lx~o~-ffic, tl'trt'l'fft~~ ....
Certificate of Occupancy Z10720
April 23 19 57 pursuant to ~q~q~-~d%~ ~g-~m~-No~.-.- ....................
dated . .O.c..~.o.b.~.r...6 ................ 19..8.1, 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 .........
The certificate is issued to Paul Harry Orlowski & Wf.
(o wrier, ~:Z~X X X
of the aforesaid building.
Suffolk County Department of Health Approval N/R
UNDERWRITERS CERTIFICATE NO. N/R
Building Inspe~or
Rev. 1/81
Location
Subdivision
BUILDING DEPARTr'~NT
TO%'~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
375 Grove Road and 50 Mill Creek Drive, Southold, N.Y.
(number & street) (Municipality)
Map No. Lot(s)
Name of O~er(s) Paul Harry 0rlowski & Wf.
Occupancy R-1
(type)
Admitted by: Mr. Orlowski
Unoccupied
{owner-ten~'~t)
Accompanied by: Mr. Orlowski
Key available
~uffolk Co. Tax No..135-3+47 +48
Source of request Abigail A. Wickham
Date Sept. 15, 1981
DVfEI.LING:
Type of construction
Foundation Cement Block
Total rooms, let. F1 5
Bathroom(s) 1
Porch, type
Breezeway
Type Heat 0il Fired
Fireplace(s) No. Exits
Domestic hotwater Yes
Other
Wood framed #stories One
Cellar FartialCrawl space Rest
2nd. F1 Drd. F1
Toilet room(s)
Deck, type
Garage
Warm Air
Type heater
Patio, type__
Utility room'
Hotwater x
Airconditioning
Tankless
ACCESSORY STRUCTURES:
Garage, type const. Wood 2 'Car
Swimming pool
Other
storage, type const.
o
Guest, type Const.
VIOLATIONS: Housing Code, Chapter 52
.,,Locati°n Description , Art. Sec. _
Garage Need repairing, door jambs rotten, door
Cellar Insulation hanging in spots from cei.ling III 52-~2-C
Remarks:
.Inspected by: ~, , ~/ Oct. 5/81
~, ~,~ ~ ~]~-~ Date of Insp.
' '%1 ' Curtis W. Horton Time start 9:3'0' end9:~5 ·
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 feat~ res.
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 (pdor to April 1957), Nonconforming 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.
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 . .S?]p..te.~...e~.. 1.5. ,. 1.9.8.1. .......
New Building ......... _~.._._,Old or Pre-existing Building ....X ........ Vacant Land .............
Location of Prope'~rtyT~...~..~....R°~..d and ~l~e~ Dri~, ~s~9, ~u~old, ~ ~ork
Hou~ No. Street Ham/et
Owner or Owners of Prope~ ~ .~. ~. ~. ~. ~ .....................
C~nW Tax Map No. 10~ Section . ~. .......... Block .... ~ ...... Lot ..... 9~].'PPP..~
Subdivision ................................. Map No ............... Lot No ...............
Permit No.. ~ ........ Date of Permit .......... Applicant ............................... ~' '0
Health Dept. Approval ........................ Labor Dept. Approval .................. ~.(~.. ~. ?~
Underwriters Approval ........................ Planning Board Approval .., ........... ~',
Request for Temporary Certificate ..................... Final Certificate . .X... ~ t~.~ ;-~,?'/~
Fee Submitted $..5,(~0 .......................
Construction on above described building and p.e_rmi/t~.ets_all.~pp~ab~e,c~odes a~d ~golations.
.
Rev. 10-10-78 ·
Encls. 0/~ ~., ~'/=~/