HomeMy WebLinkAboutZ-9535FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building ................................................
Location of Property .
HJJ~e 'No. ' .... St/e$i ............. Sollthold h$/nie~
County Tax Map No. ] 000 Sebtion . 0~5..0~,. ...... Block .. 00~. ........ Lot .... ~10 .........
Subdivision ............................... Filed Map No ......... Lot No ..............
RE~UIREHENTS FOR ONE FAI~ILY DWELLING BUILT I~IOR TO
conforms substantially to the -
CERTIFICATE OF~ OC~JPANCY
.Ap?.~.l. .... 2.~. ......... , 19~.7. pursuant to whichj)j¢~d/aV ~ No ....... Z9555 .........
dated ..... IvY. Y...~ ............... 19 .~.9, 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 .........
............. P=ivate. One .F-~ y. D~elling .wi.th .Acaessor~.. S~r~ctur. e ....
The certificate is issued to ........ Robert. ~ock~f~ller. &. wf.... ......................
of the aforesaid building.
Suffolk County Department of Health Approval ............ . .Pi? .e.-..~.i. ~..~.:[.~.g ...............
UNDERWRITERS CERTIFICATE NO .................... P.17o.-Exl,$~JJag ...............
Building Inspector
Rev 4/79
Location
Subdivision
Name of Owner(s)
Occupancy
Admitted by:
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
CODE INSPECTION REPORT
2955 LightHouse Rd.
(number & street)
Map No.
Robert Rockefeller & wf.
R-1
(type)
Helen Brown
Key available__
Source Of request
Southold, New York
(Municipality)
Lot(s)
own er
(owner-tenant)
Accompanied by: Helen Brown
Suffolk Co. Tax NoJO00-050-003-010
Helen Brown
Date May 23, 1979
DWELLING{
Type of construction Wood
Foundation wood posts
Total rooms, 1st. F1 4
Bathroom(s) 1
Porch, type cement with Deck,
roof over de~age
Breezeway
Type Heat space heater Warm Air
Fireplace(s) 1 No. Exits
Domestic hotwater yes
Other
ACCESSORY STRUCTURES:
Wood
Garage, type const. 1 1/2-car
Swimming pool
Other
#stories
Cellar Crawl space
2nd. Fi 4 3rd. Fi
Toilet room(s)
type wood Patio, type
Utility room
Hotwater
2 Airconditioning
gas
Type heater
two
Storage, type const.
Guest, type const.
VIOLATIONS:
Location
Outside
Living room
Stairway - up
Back porch
Front Porch
Housing Code, Chapter 52
Description
Chimney needs repairs
Gas heater unvented
Very narrow, r~l not right
Sills & deck rotten
Cement breaking up
IArt.I Sec.
III 52-30 B
V 52-53 H-3
II 52-27 A & B
III 52-31B
III 52-31A
Remarks:
Inspected by:
Date of Insp. May 23, 1979
Time start 10:00 end 10:30
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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 featu res.
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.
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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date .'~. .~. '. . .~. .~. , . /.~. . .~. ~. . .
New Building ............. Old or Pre-existing Building .,../'F~.. ...... Vacant Land .............
Location of Property ..,~.~..~'~. ........ '~' '~~'~'~'/~'~' ' '"'JJ"~~' ' '~- treet --
House No. Ham/et
Owner or Owners of Property ..~"~.~...~'~~...~../,~..~. ...............
County Tax Map No. 1000 Section . t.~.~..~2. ...... Block ... ~.~. ........ Lot .... ~. (.4~. ......
Subdivision ................................. Map No ............... Lot No ...............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Request for Temporary Certificate ..................... Final Certificate .
Fee Submitted $..~., ~.~2. ....................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant...~~.. ~. ........................