HomeMy WebLinkAboutZ-6330FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. .. Z6330.... Date .......... Feb .....13....... , 19.75.
THIS CERTIFIES that the building located at .. NIS • Bad ew• -Road • • • • • • • Street
Map No. ......... Block No. XX .......Lot No..xxx ..Southold . •N111 .........
conforms substantially to then. a 13Ci ilj J*l1_1_n1iou0frcode
da a
HteAit
beiwre or 2.3 .., 19.57 Pursuant to which �o. Z6.330 -
dated ........Feb • • • • 13• • • • • • , 19.7 5 . , 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 • •Privote • one - family. -dwelling .. • • • .
..............................
The certificate is issued to Philip- A • Dor is• Petes-9 • • • • • Owners• • • . • • • •
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ...prem• -existing .................
UNDERWRITERS CERTIFICATE No. . -pre— -existing• • • • • • • . • • • • • • • • •
HOUSE NUMBER ....t297.5 .... Street ... Ba-yview -Read .................. • • • • • •
................................................................................
.............. .
Building fnspect�r
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
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 pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date FebruarX 10.,.. 1.9.7.5
New Building ................ Addition ................ Old or Pre-existing Building ...X.......... vacant Land ..............
Location Of PropertyC.QX.nf r„of..Midland Parkway and Main Bavview Road, Southold
Owner Or Owners Of Property ......Philip„A. Peters Doris A. Peters, his wife
........................................................
Subdivision...............................................................Lot No. ..... :7..... Block No............ House No.............
PermitNo ..................... Date Of Permit ....................Applicant..................................................................
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....5,.,00 ......................
Construction on above described buildin........'... ...............
d regulations.
Applicant
P. Ec`1son, A�):'orney�r'"1jFi'il'ip".4':"'and
Sworn to before me this Doris A. Peters
..... 10th day of ....Febr//uarX, 19.75...... (stamp or seal)
Notary Public AS44. (.-k.......... County
RUI OOH la BRUER J
*OTARY NL iC, o 'e of New Yark
No, 6624',6°, --I fclk County
6otnmiss;on:r ..: � 3J. 1975
HOUSING CODE INSPECTION
February 11, 1975
12975 Main Bayview Road R-1
Southold, New York
Tax Roll: Philip Peters & Wife
Upon receipt of an application for a Pre -Existing Certificate
of Occupancy, I made an inspection of this two story framed
dwelling. I was admitted to building by Mrs. Peters who
accompanied me during inspection, which started at 3:20 P.M.
The first floor consists of a kitchen, living room, dining
room, bedroom and full bathroom. The second floor consists
of two bedrooms, full bathroom and a storage room. Heat is
furnished to all rooms from an oil fired hot water heater
located in full cellar. A two car garage is attached to east
side of dwelling by a breezeway.
I found no violations of The Housing Code, Chapter 52, Town
of Southold, N. Y.
Building and grounds are in good condition. Inspection com-
pleted at approximately 3:45 P.M.
Respectfully ubmitted,
EH:mm ward Hindermann
Building Inspector
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