HomeMy WebLinkAboutZ-10557FORM NO.4
BUIL t 1f G x TM&
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
210557
No .................. Date .... July. 1....................., 1 SBA .
THIS CERTIFIES that the building ................................................
Location of Property...... flld • Shipyard . Lane + .. Southold, New York
House No. Street Hem%t
County Tax Map No. 1000 Section .... 0 ...... Block ....4 ..........Lot ...... ??........ .
Subdivision ....goundera. Estates ... • • ...Filed Map No. . 83�...Lot No. .. 91........ .
conforms substantially to the ,� is�tiwm as Pr 0e f m1q L -0l 99- ,j,Z, it prior to
April 23 5 t which B�w�rrrot' Occupancy Z10557
.................... .19.. pursuant o w ...............
dated ..... JulY 1 ................ 19 8!. , 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 .........
..........r!r ylk ;q .One ,Family, Dwolling .... .............................. .
The certificate is issued to ... a ? ter . kie. .490 c o e8o W P . . ........ _ .
(owner, /&59�9aC.tBQ�E d--- .
of the aforesaid building.
Suffolk County Department of Health Approval, ....... 1111 ...............................
UNDERWRITERS CERTIFICATE NO ...... XIP .........................................
. Building Inspector
Rev. 1/81
I— _
BUILDING DEPARTMENT
TOtiM OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 910 Old Shipyard Lane, Southold, New York
number & street Municipality
Subdivision Founders Estate Map No. 834 Lot(s) 91
Name of Owner(s)
Walter H. Roscoe & Wf.
Occupancy R-1
type owner -tenant
Admitted by: Self Accompanied by: Self
Key available Mrs. Meredith
Suffolk Co. Tax No64.-4-22
Source of request R. G. Terry, Jr.
Date June 20, 1981
DWELLING:
Type of construction Wood Framed ##stories 1
Foundation Cement Block Cellar Full Crawl space
Total rooms, 1st. F1 F 2nd. Fl 3rd. F1
Bathroom(s) 1 Toilet rooms)
Porch, type_
Glass-screerEoelCkp type
Patio, type
Breezeway Garage 1 Car Utility room 1
Type Heat Oil Fired Warm Air Central Hotwater
Fireplace(s) , No. Exits 3 Airconditioning
Domestic hotwater Yes Type heater Gas
Other
ACCESSORY STRUCTURES:
Garage, type const.__
Swimming pool
Other
Storage, type const. wood
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location
Description
Art.
Sec.
Kitchen
Gas Stove no shut off
V
52 -52 -E -i
Remarks:
Inspected by: �,w, ate of Insp.June 30 1981
Time start2:30 end 3:00
Curtis W. Horton
I
�3 v 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
��(( Date 'r!^^Q �� I .I •ll�! ........
New Building ............. Old or Pre-existing B�uildiin X....... Vacant Land .. ......... .
Location of Property ......................V.`+... . .. .. ad ............ .
House No. reet Hamlet
Owner or Owners of Property ......... ... oZ4 �`^r!^^y. !!�' P.� . .6??�G�'�a I
County Tax Map No. 1,0,000 Section ...... �If..... Block ...... t ...... Lot ...Zp.......... .
Subdivision .?^!�.. C%?....... Filed Map No. �3 ....Lot No. . `. .
Permit No. .......... Date of Permit ..........Applicant ..................................
Health Dept. Approval ........................Labor Dept. Approval ........................ }�
i
Underwriters Approval ........................Planning Board Approval
Request for Temporary Certificate .....................Final Certificate ...................:
Fee Submitted $ .............................
Construction on above described building and per it eets all applicable codes and regulations.
Applicant ... ... q -o .. .. �
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