HomeMy WebLinkAboutZ-9955FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.....Z9955....... Date ......May'. .27 .................... 19 80
THIS CERTIFIES that the building ................................................
Location of Property ,..s 2190 Village Lane Orient, N.Y.
House No. Street ' Hamlet
County Tax Map No. 1000 Section ..... 26 ....Block ... l........... Lot .......1 ........ .
Subdivision ......Bayside .......Filed Map No. ........Lot No. ........ . .
requirements for a two-family dwelling built prior to
conforms substantially to theX altl 6lc�Jllw �4i47�1tDsxdf8A9[ tlyd[
Certificate of Occupancy
April , 2j
........... 19 5.7, pursuant to which 9&1RhT44*3 PM.299
..................55...
dated ..... P*Y. 27 ............... 19 $P , 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 .........
A Tyro. (2) .Family, 3eaeo4al. Dwelling. in A. Zone. DistirXAt ..............
The certificate is issued to ....... Regents International Corp.
(owner, XAMEXeafr76II"
of the aforesaid building.
Suffolk Count e of Health
Y Department P Approval ............0 ..........................
UNDERWRITERS CERTIFICATE NO .................... NA ....... ... .
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Building Inspector
Rev 4/79
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BuILDILTG DEPARTMENT
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TOjIN OF SOUTFiOLD, N. Y.
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CODE INSPECTION REPORT
HOUSING
Location
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et
Ifunici alit
P. y
number str
Map No.--
Lot(s)
Subdivision
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Name of Owners)
-,
Occupancy
ozmer-ten t
• 4-ir a
'Admitted
Accompanied
AXX La." V Vasa w - - -- - -
• Porch; type beck, type Patio, ; type .. -
Breezeway Garage -- Utility room
Type Heat - ' *Harm Air Hot�tater
Fireplace(s) No. Exits Airconditioning�l�
Domestic hotwater ..Type heater -
01 "
- Other
ACCESSORY STRUCTURES:
Garage, type const: Storage, type const.
Swimming pool Guest, type const.
Other
• VIOLATIONS: Housing Code, Chapter 52 -
Remarks :,,,.,_-aot
Inspected by;
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FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
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 Inspec-
tor 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 installa-
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), Non -conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey 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.
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
)!Fe
Date........... .
New Building .. IRS.. Old or Pre-existing uilding ✓... Vacant Land ............ .
Location of Property �f..4XV �E ..�/..... . r
House No. Street Hamlet
Owneror Owners of Property .. e b ...........�:....................... .
County Tax Map No. 1000 Section ...2 b........ Block ......... Lot ...... I.........
Subdivision .................................Filed Map No. .........Lot No. ..... L..
Permit No. .......... Date of Permit ..........Applicant 1N4.,. c�1�1
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval .. ...................Planning Board Approval ......................
Request for Temporary Certificate .....................Final Certificate .... .-............ .
Fee Submitted $ ...... S ...................
Construction on above described building and permit me is all licable codes and regulations.
Applicant.F. . .. .........................
Rev. 10-10-79
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