The URL can be used to link to this page

Home My WebLink AboutZ-9467FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z.9.~6.7 ..... Date .... .Ma.r'..c.h... ?.~ ............. , 19.7.;9. THIS CERTIFIES that the building located at ../4.8.(5.5.0...M.a.~.n...R.o.a.d. ......... ~ Map No ............. Block No ........... Lot No .................................. conforms substantially to the ~f ..... ~ TO Q]~TIFI~,~TE _OF QC~UPANCY ~ .... .Ap?.~.Z....2.~. ....... , 19..5.7. pursuant to wnlcn ~~.t 1~o.. Z946.7. dated . .Maroh. · .~6 .......... , 19..?~ was issued, and conforms to all of the require- ments of. the applicable provisions of the law. The occupancy for which this certificate is issued is ..... .P~.lya.t.e..0n.e..Fa~nil¥. D~.elll~g..wttk A¢o~s.~ory..$~r~tur.e ..... The certificate is issued to ....... .(]~co. Scbmltt. &..wf ............................. (owner, ~) of the aforesaid building. Suffolk County Department of Health Approval ...... p~..e.-..E~..i.s.~..i.n~ ............... UNDERWRITERS CERTIFICATE No ............... . .P~..e.-..E~.i.s..t.i.n.g ............... HOUSE NUMBER...~.8~ .0 ...... Stree, ....... ../. ,, ~.:~.....~.o.~..~.. ................... ( ................................................~' /{~~/~4~....~"~u'~" g,. ~..¥, ............. Building Inspector County Tax Number 1000~070-07-012 FORM NO. $ TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Iflstructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 installations, 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 property 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 in- formation 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 New Building ................ Addition ................. Old or Pre-existing Building ...... ~ .......Vacant Land .............. _ ~o o. ?ax a 0 LOcation Of Property ~.~f~.t;~i~`~..q~.t~..~d.~.~"~[~i.~..qi~i~.q~a~`~`~2 ~;)Wner Or Owners Of Property ..[~I,I[';I,.~L.~.,....~I~]~..~.t;.~ .............................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .~,..~.......&....~.,1~.~,~...~....~...,.~ Health ' Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......... X. .............................. Fee Submitted $ ..~.,.0.0. ........................ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this .... x3.~..~..., day of .... ~.~.3;~tR~¢3~...,[.~..~.~.~ ...... Notary Public ,.,~,~,~.,~.o..].,,,~. ................. County, Applicant ......................................................................................................... ~ARY DIANA FOSTER I~IOTRRY PUBLIC, State o! ?~" ¥oTk NO. 524655242, Suttol!~ ~Commissi0n ~pires ~arch 30, 1979 (stamp or seal) BUIr.mlNG DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location Subdivision Name of Owner(s) Occupancy /2--/ (type) Admitted by: (number & street) Map No. ~-~o T/wo~ZP -- /v-7. (Municipality) ' - Lot(s) ------ (owner-t chant) Accompanied by: Key available Source of request~ Suffolk Co. Tax No./00o - 0 70 -0 7~/2 D~fELLING: Type of construction Foundation ~o~,.v~ .(~c~ Cellar~7-~ Total rooms, 1st. F1 ~ 2nd. FI.~ #stories '-7-"/00 .- Crawl space 3rd. F1 Bathroom(~ Porch, type~--~o~T~'~ Deck, type Breezeway Garage Type Heat ~/~ "Warm Air -- Fireplace(~ ~- No. Exits Domestic hotwater///~~y. Other Patio, type Utility room HoL~ater~FFL~/~-~ Airconditioning Type heater ~g ACCESSORY STRUCTURES: Garage, type const. R~vom Swimming pool -~ Other Storage, type const. Guest, type const. VIOLATIONS: Housing Code, Chapter 52 Location r,4~,~,~,,,,0 Description Art. Sec. o'-z-z R ('-,0 M (vD Remarks: ~ ~/ . Inspected by: ~~~Z~~Date of Insp. Time start/O-'~-~end/WOO ~.