HomeMy WebLinkAboutZ-10203FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No ...... 2i 02Q3 ..... Date ..... October . ?.. ..............1 19 80
THIS CERTIFIES that the building ................................................
Location of Property 1.585. Hobart .Road, ........Southold,. A.Y... .
/-louse No. Street Ham%t
County Tax Map No. 1000 Section .. 64 .......Block ... 2 ..........Lot .. 1.3 ............
Subdivision .Founders'..Landing .......... Filed Map No. . 8. -...Lot No. .18......... .
14
requiremer ts.BP.o a One-I�ramt ro gni s.o It to
conforms substantially toe-Appkoat�e rig -Inert-
. ,April .23........... 1957. purFU%9PAafA 2vt %i MR 1...Z1020,3 ...........
dated ...October. 1.5 ............. 19 .80, 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 .........
...Private. OneTFamily. Dwelling .............................................
The certificate is issued to ......Robert . and . Helen . 1chmond .......... • ..... • .. • .
ownerjejekex9f"c
of the aforesaid building.
Suffolk County Department of Health Approval ... NM ...................................
UNDERWRITERS CERTIFICATE NO........... NIR ...................................
1
. . . . . . . . . . .i1. .
. . . . . . . . . . . . . . .
Building Inspector
Rev 4/79
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 surrey 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
Date .. 4��. �,/..1. AX 10.
New Building ............. Old or Pre-existing Building .-X....... Vacant Land .............
Location of Property i -r g 5 (4 r73A�7 ...... -Fo A D Go U T H 0�
........................................
House No. Street � Hamlet
Owner or Owners of Property( . "........ J1�
County Tax Ma No. 100.0/ -Section ....... rv. l .... Block .......`....... Lot .... /.��....... .
Subdivision . ��''! .. ......Filed Map No. .�`� y..Lot No. !
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 $ .......................
Construction on above described building and
�permit
,meets all applicable
codes and regulations.
Applicant.. ..!/ ./d: ..J/ .............
Rev. 10-10-78
41
114
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location /5 3S H0'F�:?AZ27 /-U::'0 A Z> so V 7H0 cl'-s
number & street Municipality
Subdivision ROVA/.btRS 4A ND/NG-Map No. �?-3`% Lot(s) i g
Name of Owner(s)
Occupancy,
Admitted by:
fjAT ol.b 7- ♦- "AIVG`r 7? 16 H/Vlo nim (tS7A
type)
,k n, AV- /-
d (owner -tenant)
Accompanied by: /-,W /kms-►
Key available ` ° ^, Suffolk Co: Tax No.
Source of request "l' -W" Date
DWELLING:
Type of construction ,#stories -2-
Foundation
Foundation 6'11141+r_A W.-- Cellar. ; .;W Crawl space "Y °
Total rooms, 1st. Fl +l0 2nd. Fl / ¢ ZtkL 3rd.. Fl
Bathroom (s) O>XA Toilet room(s)
Porch, type `7VV__4_ Deck, type hl--. Patio, type yw�
Breezeway Garage Utility room
Type Heat q*,O- 'rearm Air Hotwater ✓
Fireplace(s) 070___-- No. Exit,,� _Airconditioning '�—
Domestic hotwater a heater
Other.
ACCESSORY STRUCTURES: l r
Garage, type const. l.J0�6 Storage, type const.
Swimming pool Guest, type const.
Other �.�2�•-c��- �» y�^�(
VIOLATIONS: Housing Code, Chapter 52
Location
Description
Art.
Sec.
a4lUavis ,A,,,,If
aid .� /t,c� S. L± Go-►�u�
Remarks:
Inspected by:
s A,$^ q ter/ Cp"r,4
Date of Insp.
Time start *-It P"', end /: W7 %tiI.
!LL_
go