HomeMy WebLinkAboutZ-9079FO~ NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
No.. Z9.°.7.? ..... Date June 22 19 ?8
THIS CERTIFIES that the building located at ... ~.7.~., .C.r.t.t..~.e.n.s...L.m~..e. .... Street
Map No ............. Block No ........... Lot No.
REQU~S FOR 6NE' '~AM/L'Y 'DWELLING 'BUILT 'BEFORE
conforms substantially to the ~l.~ - Ct~TIF
dated ... Ap.r.i. 1....2.~. ........, 19. ?,7. pursuant to which ~ No..Z?.0.7.?..
dated ....~..u~.e. .... 2.2. ........., 19.?.8., 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 ...... .P~..I.VA.T.E. 0.NE. F...A~...Y. .D..W~..".'.IN.G... '. ...............................
The certificate is issued to CaA~oll Petrowski
(owner, ~
of the aforesaid building.
Pre-Existing
Suffolk County Department of Health Approval ....................................
Pre-Exis~ing
UNDERWRITERS CERTIFICATE No .............................................
HOUSE NUMBER .... .57.5. ......Street Crittens Lane
Southold, New York
Building Inspector
Housing Code Inspection
June 20, 1978
575 Critten Lane
Southold, New York
Tax Roll: Carroll Petrowski
occupied
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy, I made an inspection of the dwelling on this premises.
I began this inspection at approximately 1:00 P.M.. with Mr. Petrowski.
Located on this property is a two story wood frsmed structure.
This is a single fsmily dwelling. No accessory buildings are located
on the property.
Cellar is a full cellar, cement block, no outside entrance. Cellar
is partially finished off consisting of two paneled rooms, work
shop and heater room. Electric panel, oil fired hotwater heater,and
pump and tank all in good shape.
First floor consists of living room with fireplace, dining room,
den with patio outside, full bath and a combination kitchen-dinette.
Attached to the first floor is a two car garage with two entrances.
Second floor consists of three bedrooms, f,,ll bath and a large
cedar closet. --- -
The outside of this dwelling "roof, sidewalks, windows, side
walls etc. "are in excellent condition.
No violations of the Housing Code, Chapter 52, Code of the Town
of Southold, N.Y. were found.
Inspection completed at 1:45 P.M.
RespectD,lly submitted,
CURTIS HORTON
Building Inspector
FORM NO. $
TOWN OF $OUTHOLD
, Building Deportment
Town Clerks Office
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
Inspector 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
installations, 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 property 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 in-
formation required to prepare a certificate.
C. Fees: I. 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 ~
....
New B~lilding ................ Addition ................ Old or Pre-existing Building .... ~ .... Vacant Land ..............
Location Of Property .............. ~.~~',~.~.....~.....~.....~.; ..... ~./~.o/...~/~.z~.~...~.
Permit No. ' --~ ' ~
- Date Of Permit .................... Apphcant ....... ;~.., ...............................................
Health D~pt. Approval .......................... I~bor D~t. Approval .............................
Underwriters Approval ........................... Plonn' g Board Approval .~/...~.' ....................
Request For Temporary Certificate ......................................... Fined Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building a/l~ permit mee~ all applicable~odes and regulations.
Sworn to before me this
................ day of ............................................
Notary Public .................................... County