HomeMy WebLinkAboutZ-10629FORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
5outhold, N.Y.
Certificate Of Occupancy
Z10629
No ..................
THIS CERTIFIES that the building ................................................
Location of Property 40 Fox HolloW Road, Mattituck, New York
House No. Street Ham/et
County Tax Map No. 1000 Section ...~.[.3. ...... Block ...... 6. ........ Lot ...... [.8. .........
Subdivision ............................... Filed Map No ......... Lot No ..............
.,Regulrementa ~Q;*,.a ~ne-..F~mi,~ Dw~fll~n~.Bu~ilt Prior
conforms substantially to [ne ~pl~e~,e~i~r-~a~ld.h,~Perm~l~,m'or~-imewm-P~is-~m~-
Certificate of 0ccupancYZl0629
April 23 19 57 pursuant to which B~il~it'N'~.-. ....................
81
dated August ............................ 11 19..., 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 One-Family Dwelling
Albert Rohrer
The certificate is issued to
..................... .....................
of the aforesaid building.
Suffolk County Department of Health Approval ..... ~./.R ..................................
UNDERWRITERS CERTIFICATE NO. N/R
to
Building Inspector
Rev. 1/81
Location
BUILDING DEPAP, T[,~NT
TOl'g[ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
40 Fox Hollow Road, Mattituck, New York
(number & street) (Municipality)
Subdivision
Name of 0~mer(s)
Occupancy
Admitted by:
R-1
(type)
Self
Albert Rohrer
Key available First Towne
Source of request
Map No. Lot(s)
Unoccupied
(owner-tenm',t)
Accompanied by: Self
Suffolk Co. Tax No..113-6-18
Date July 10,'81
Richard F. Lark, E'sq.
D~LING:
Type of construction Wood Framed
Foundation Cement Block
Total rooms, 1st. Fi 5
Bathroom(s) 2
Porch, type
Breezeway
Type Heat 0il Fired
Fireplace(s) 1
Domestic hotwater Yes
Other
#stories
CellarFull Crawl space
2nd. F1 3rd. FI
Toilet room(s)
Deck, type
Garage 2 Car
Warm Air x
No. Exits 2
TYPe heater
Patio, type g~te
Utility room
Hotwater
Airconditioning.
Electric
ACCESSORY STRUCTURES: NONE
.Garage, type const.
Swimming pool
Other
storage, type const.
Guest, type Const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Ar,t,. Sec.
Cellar No rail cellar steps II 52-27-B
Remarks:
.Inspected by: ~~.~ ~.~ ,_~,.~ Date of Insp. 8/11/81
Curtis W. Horton Time start ' end
11
12:00
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.
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 unusua~ 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
New Building ............. Old or Pre-existing Building ...X. ........ Vacant Land .............
Location of Property . .~. .... ~.o. ?. ?.o..1.1.o?...R.o.a.~. ..................... .H.a.~..~.~.~.? .~ ........
House No, Street Hamlet
Owner or Owners of Property .... ,~,o.s.e..~.h.~.n.e., .~.o.~.~. ? .r .....................................
County Tax Map No. 1000 Section ...]:]:..3 ......... Block ....... 6. ....... Lot ..... ~.8. .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ............................ ~ .....
Health Dept. Approval ........................ Labor Dept. Approval ................. -~;.. (~...
b
Underwriters Approval ........................ Planning Board Approval ..........
Request for Temporary Certificate ..................... Final Certificate ............
Fee Submitted $..5; .0.0. .......................
Construction on above described building andyne codes and regulations.
~i~h~Y~d'F'.L~T~k',~E§q., a~orney for applicant
Rev. 10-10-78