HomeMy WebLinkAboutZ-10395FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
210395 Date ....r. '�•rila4 - ?^.............. 1 y
No.................. 9...
THIS CERTIFIES that the building ................................................
Location of Property :`..' .:`."... .....1' C C, 11
....11 i C :... ' .. .
House No. Street Hamlet
County Tax Map No. 1000 Section .. .1..6 ......Block ....... ........Lot .... ..!. l` ........ .
Subdivision ...............................Filed Map No. ........Lot No. .............
requiromento for a one -family dwelling built prior to
conforms substantially to 'M ApprcaTion 'foi•' Bui'Tding permif TTeretOTOre tMFcT Tri This officedated -
i S,.'., `: " Certificate of Occurs; ricy _ ,
19 ' 1 pursuant to wl+ie Bi irrg•Perm�t No - .........�: U 9
dated ?. s............ 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 .........
The certificate is issued to ... P'.r:er, r. i, c k L. 1: r..hu .l. t %
(owner, lessee_.ar. tenand _ _
of the aforesaid building.
Suffolk County Department of Health Approval ......S /. R .................................
UNDERWRITERS CERTIFICATE NO..... 14 J. .........................................
--r
buildingInspector
Rev. 1/81
R
BUILDING DEPARTMENT
T01IN OF SOUTHOLD, 17. Y.
HOUSING CODE INSPECTION REPORT
Location 3375 Wells Road, Peconic, N.Y.
number & street) Iiunicipality
Subdivision Map No. Lots)
Name of Owner(s) Frederick L. Schultz
Occupancy R-1 Owner
type owner -tenant
Admitted by: Mr. Schultz Accompanied by:_ Mr. Schultz
Key available
Suffolk Co. `rax No. . 086-02-008
Source of request Richard F. Lark
DWELLING
Type of construction Wood
Foundation Cement Block Cellar
Total rooms, 1st. F1 4 2nd. Fl
Batliro6m(s) 1 Toilet room(s)
Porch, type Deck, type
Date Feb. 18, 1981
�#stories
One
Crawl space
3rd. Fl
Patio, type
Breezeway Garage 1 Car Utility room
Type Heat Oil Fired 'alarm A&r Hotwater
Fireplace(s) X No. Exits 3 �Airconditioning
Domestic hotwater Yes Type heater Electric
Other Finished room in basement
ACCESSORY STRUCTURES:
Garage, type const._
Swimming pool
Other
NONE
____Storage, type const.
Guest, t,rpe const.
VIOLATIONS: Housing Code, Chapter 52
Location
DescriUtion
Art,
Sec.
Outside
Hojase�e�ds oain;n� ba_d�y
52-30-B
Outside,
_ Front door needs fixing
III
52-31-B
electric boxes
V
2-56-1
Cellar
Wires Loose hot water beater
Remarks:
Inspected by: C��`� Date of Insp. 2/20/81
Curtis Horton Time start 2:00 end 2:30
7
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 .February .18.,. 1981, .. .
New Building ............. Old or Pre-existing Building .....X...... Vacant Land .............
Location of Property........................Wells Road . . . . . . . ... . ... Peconic, , , , , , ,
......
House No. Street Hamlet
Owner or Owners of Property... L. Schultze
............................................................
County Tax Map No. 1000 Section ... 86 ......... Block ..... ?......... Lot ... ............
Subdivision .................................Filed Map No. ..........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 $ 5.00 ........................
Construction on above described building and
permit mneets all M
able codes and regulations.
Applicant . . (1d�.....f........
Richard F. Lark, attorney o.r ap.pl...icant.....
Rev. 10-10-78
�l7!