HomeMy WebLinkAboutZ-10677FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Z10677
NO ..................
Date September 10 19 81
THIS CERTIFIES that the building ................................................
2015 Ba Avenue, East Marion, New York
Location of Property Y .~: ..................................
House No. Street Hamlet
County Tax Map No. I000 Section . .0.3. 1. ....... Block .... 1.7. ......... Lot .. p. q2. ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
Requirements for a One-Family Dwellin~ Built Prior to
con forms substantially to the-~p~li~t~'n- for-B~il'd/a~'~ Perm~h'c-'re~fayre' -fitc~l: i'n-' tTfi~- ~f'f'ret~ 'd~lt~fl- - -
April 23 57 Certi£icate of OccupancYZl0677
..................... , 19 ... pursuant to which-B'~l~in~'l~-~li"N"o-. .....................
dated S e p t e mb ~lr 1 0 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
of the aforesaid building.
[o wn e,'x ~q~,~x ~'a,~X)x x x x
Suffolk County Department of Health Approval ..... ~ ./~ ..................................
UNDERWRITERS CERTIFICATE NO... ~/.~ ...........................................
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/
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 ,,4,~.<,.,~,~, % ?~. ~ ,~. , ,' ~*
~' ,/-77~ i ~? , ~,,*
/ /.~ ~ ~ ~.~ ,, ' I .I',~ . ., ~ ~..__.
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Budding~spec-
tot with the following; for new buildings or new use:
1. Final ,mrvey of property with accurate location of aH buildings, property tines, streets, and unusual
2. Final approval of Health Dept. of water supply and sewerage dispo~al-{S-O form or equal}.
3. Approval of electrical installation from Board of Fire Underwriters. installa-
4. Commercial buildings~ Industrial buildings~ Multiple Residences and similar buildings and
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), Nomconforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survev 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:
J. 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
New Building ............. Old or Pre-existing Building ............ Vacant Lapd .............
House No, ~ Street Ham/et
Owner or Owners of Property ....~..~....~....~.~.~.'....,.~.~.~.?..~T.~. ......................
County Tax Map No. 1000 Section ...~..'~'../. ....... Block ..... ./.~. .......Lot .... ~../~'..."~. ......
Subdivision ................................. Filed Map No ........... Lot No ............. .~ ~,~
Permit No ........... Date of Permit .......... App icant .............................. ~. ~.. ,
Health Dept Approval Labor Dept Approval ................. ,~,~.
Request for Temporary Certificate Final Certificate
Fee Submitted $ ~. .......................... ~v/Ib ~/'
Construction on above described building and p.~.-fnit meets all applicable codes and regulations,
Rev. 10-10-78
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ~:~Ol~-- ~/~ /~U~.
(number & s~reet)
Subdivision ~ Map No.
(Municipality)
- Lot(s)
Name of Owner(s)
0 c cup an cy /~--/ ~2~/x~--~ ~d~/~/~2 ~
(tYPe) ( o~er-ten~t }
A~itted by: ~--C~ Accomp~ied by: ~_~
Key available ~T ~y~d ~ Suffolk Co. T~ No../~/-/Z--OO~
/
Souroe D te
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DWELLING:
Type of construction /~//~-~P
Foundation ~'~h'~' ~C~ /~/~z3~.3 Cellar
Total rooms, let. FI ~/~¥~ 2nd. FI
Bathroom(s) ~/~ Toilet room(s)
Porch, type,~$-~c~- Deck, type.
Breezeway. -~- Garage.
Type Heat g-~ Warm Air
Fireplace(s) /_y~ No. Exits
Domestic hotwater
Other
#stories ~/w~
Crawl space C3~__~/
3rd. F1 '-
Patio, type
Utility room
Hotwater
Airconditionin~
Type heater ~Z-/ff~/~i.
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const. /L/~/-~g_
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Inspected by:~Z/ ~~Date of Insp. ~. ~ ~'~f'
- ' Time start~;'/~/~A/snd -~':--~'~/~'/'~'