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Home My WebLink AboutZ-6789FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6789....... Date .. J OY60er..19n............ 19-75 THIS CERTIFIES that the building located at 1#r2. Qt• .Peaanie..Bay. Allftreet Map No.. XX ........ Block No. AX....... Lot No. Xx ........ Iui'et N2.9, . B a. 2..... . re resents for Dain fans dxell ! Hansin conforms substantially to the built before rtifieate of Qeeupan dated ...... April.23.E ....., 19.%?. pursuant to No.Z66 . . dated .. NaTesbar.19, . . . . . ., 19. 75, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Primate. am, tam2 ..d"3.lin .......................... I .... The certificate is issued to .Charles. K..Pospieii . • • • ............................ ( owner, 1� of the aforesaid building. Suffolk County Department of Health Approval ... B/A ............................. code UNDERWRITERS CERTIFICATE No. ........................................ HOUSE NUMBER . ........ Street . Qt. P'eooai¢. Dar. 4f4..... Lat' ";%9, N. Z. ............................................ ................. ................. Building Inspector HOUSING CODE INSPECTION November 19, 1975 4950 Great Peconic Bay Blvd. R.1 Laurel, N. Y. Tax Roll: Charles K. Pospisil Occupied, owners Upon receipt of an application for a Pre -Existing Certificate of Occupancy, I made an inspection of this one story framed dwelling. I was admitted to building by Mrs. Pospisil who accompanied me during this inspection which began at approxi- mately 3:15 P.M. The building has four bedrooms, living room, dininq.- room, bathroom, and kitchen. Heat is furnished to all Afrom an oil fired hot water furnace located in full cellar. An enclosed porch is located on front side of dwelling and a one car garage is attached to west side of building. I found no violations of The Housing Code, Chapter 52, Town of Southold, N. Y. Building and open yard area are in good condition. Inspection completed at approximately 3:35 P.M. Res tfully submitted, EH:mm Edward Hindermann Building Inspector �o 1 d 0 FORM NO. 6 TOWN OF SOUTHOLD Building Department 11p C Q Town Clerks Office Southold, N. Y. 11971 J 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 pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 // Date ......!'.!...��l..�.�..................... New Building ................ Addition ................ Old or Pre-existing Building .... %X..... Vacant (Land .............. Location Of Property .. /.... @<-4?!Z./k9C�... A.�G......1J.1.1� ...........4.�f Pii..✓. 1...y../.Y...��... Owner Or Owners Of Property f`»�..1.`...`6.1.\lC./.1+',11�.....QS��...j.?................................. � Subdivision................................................................Lot No............. Block No............. House No..�. ..�.....a Permit No ..................... Date Of Permit ....................Applicant.................................................................. Health Dept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...V..i .................... `9o." z Construction on above des ibed building and Applicant ............ Sworn oto before menthh' f r1 ........... day of ..j!!..N.y^^. ...........C�.. I....... Notary Public..........v��.,.......... County t ryr€e applicabli9f codes and regulations. Q �............ . ......... ........... ................. y, Y � ` (stomp or seal) CATHLEEN A. COLLINS NOTARY PUBLIC, State of New York No. 52-3308529 Qualified in Suffolk County Cor.:mission Expires March 30, 1977 TITLE N0. S- 544352 Py 0 0 Q�G ST v S 73018 �p W forme orrly M no", AF =MONUMENT OF NF�y PRD W `0 \a �o R yo 2 REVISIONS YOUNG & •YOU G 400 OSTRANDER AVENUE, RIVERHEA WZ,YORK ' ALDEN ¢F c 55��qq 46 W. YOUNG Fff, W3 UN - PROFESSIONAL ENGINEER ANDlt0a��'g999,yU^R EY 14 LAND SURVEYOR. N.Y.S. LIC. NO. 12845 N. CTC. .4 9 SURVEY FOR: UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION � ' JOSEPH S. CONNELLY & ELIZABETH T. CONNELLY 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING w - THE LAND SURVEYORS INKED SEAL OR .. - EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY AT GUARANTEED TO: _ LAUREL R/VERHEAD SAV/NGS BANK GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE TOWN OF SECURITY TITLE B GUARANTY CO. SURVEY IS PREPARED, AND ON HIS BEHALF SOU/T HOLD ' TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE -SUFFOLK CO., N. Y. eY LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. SCALE:,� , DATE: / = 20 NO. AUG. /3, 1975 I 75-538 _ _ _ _ l' � �� 1 ��e�- � 9, �97� _-- ,_. ,mac. _ � � �� _- -- .<2._.--__ _ ____._