The URL can be used to link to this page

Home My WebLink AboutZ-9569 BFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No....g.9.~69 ......... Date ......... June. 1B.r .............. 19 3.9 THIS CERTIFIES that the building ................................................ Location of Property . 3.50. Lakeview. To-rra¢~,... ~}r'e~i Ea, stz. Ma. mion.,..New- House No. County Tax Map No. ]000 Section ...Q31 ...... Block ..... 09 ........ Lot.. O1.8 ........... Subdivision XXX .................... Filed Map No. XX.X .... Lot No... XK-X- ....... Requirements for a P.r. ivate.One Famil~f pwe.%~in~ conforms substantially to the Certifi, c. Rt~ .{)il~ OgcuP.~%~cy A~6.9 to..~.p.=~.t..2..3, ......... , 19 ~7. pursuant to wmc~#l~gl~R~lg mo ................... dated .3un~ · 1 $ .,... 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 ......... .......... ~R~V. ATE.,..ONE. F. AMILY. DWR.~.LING. ( SEA S 0 N AL 1 ....................... The certificate is issued to ...E.d.w.a. lrgl..F. ~. ~d .~ar. garek .Pohlig.. ..................... (owner,~~ of the aforesaid building. Suffolk County Department of Health Approval ........ P..R~..-.I~.X..~ .S.~.~..N.G .................... UNDERWRITERS CERTIFICATE NO ................ ~..m~..-.gX..X.S~?. 9 .................... prior Building Inspector Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location Subdivision N~me of Owner(s) Occupancy (type) Admitted by: ~. (number & street) Map No. (Municipality --- Lot(s) (owner-tenant) Accompanied by: ~~ Key available Suffolk Co. Tax Source of request~/~. Date DWT~,LING: Type of construction ~(~,oo~ t~,4,~ Foundation ~/W,~ /-;'~;~c/ Cellar Total rooms, 1st. F1 /mo ' 2nd. F1 Bathroom(~ ~ Toilet room(s) Porch, type~¢~'~ Deck, type Breezeway Garage Type Heat~.~-~ "Warm Air Fireplace(s) - No. Exits ~-~ #stories O~.~ Crawl space .~ 3rd. Fi Patio, type.~ Utility room Hotwater -- Airconditioning Storage, type const. Guest, type const. Domestic hotwater-~a-~4/g~-'~k~FNType heater ~'~ ~-/~ Other ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other VIOLATIONS: Housing Code, Chapter 52 Location Description , Art. Sec. FORM NO. 6 TOWN OF SOUTHOLD 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on $5.00 / ~ pre-existing dwelling or land use 3. Copy of certificate ofoccupancy $1 O0 ~ ~ ~ .~~i~''''t i Dote ....................... New Building .................... Old or P · ex~sttn Buddt ,,~ ,_ ....... .......... ................... Locotion Of Property ..~.....~....~.... ~ ~' .~.~,~.~ ...~ ... Owner Or Owners Of Property .................. ~ .... ..~......~...,1~ .............................................. Subdivision ................................................................ Lot No .............Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempora~_l~icate ........................................Final Certificate ........... ..~ ....................... Fee Submitted $ .... .~.....~. ............. Construction on above described building and permit meets all applic~le codes and regulations. · , /~plicant ...... .~..~..~..~.....~..~~.., .................................. Notary P~ GARy I~NNEE OtSEN~'''' t4otary Pub~'C, Stale of New'Yoltl No. 52- 2959600 Qualified in Suffolk Counl~ Term EXpires March 30,