HomeMy WebLinkAboutZ-9588FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No- ..7,9588.......... Date ............... July. l.l; ........ 197.9 .
THIS CERTIFIES that the building ............................................... .
Location of Property ..37�- urtis•Plaee,•Peconi ••••••••••••••••..........A;•••
House o. treet Ham/et
County Tax Map No. 1000 Section ... p67 ...... Block ...04 ..........Lot ...017.......... .
Subdivision . Pseona.c • shares•,• Sec. • •2 • ..Filed Map No. ..654...Lot No. -10-2-103 .• • •
Requirements for a Private One W&y 4&bui t prior
conforms substantially to tlieXi}i1�tX}tR
sero ic cu yy . ,Z95.a8........... .
to April 23, 19 5.7. puriianttto wluc % �f_i.
dated ............ 3uly •1.1; ...... 19 79. , 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 . DWELLIN.G.....................................
The certificate is issued to . Emil. & Anna .Siebert ...................................
(owner, /RSfV.)eic3lVA
of the aforesaid building.
Suffolk County Department of Health Approval .....P RC-EXIST.ING.......................
UNDERWRITERS CERTIFICATE NO ............. PRErEXIST.ING..........................
............ ...........................
Building Inspector
Rev V78
FORM NO.6 For access call Siebert: 7652410
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 $1.00
Date ..?uly 11.P. 1979,.,.,,.,,
New Building Old or Pre-existing Building ..X......... Vacant Land
............. .............
93st*Xj:9 tx8a$xX82fXRjrkX3t*XZX*X1?
Location of Property Burtis P a e� Pecon c S ores, Peconic, N.Y.
House No. Street Ham/et
Owner or Owners of Property ,EmilSiebert and Anna. Siebert
County Tax Map No. 1G 0/Ir( ction ...67.......... Block ... A .......... Lot .....17. .
Subdivisio n.... °��� .:( y .........Map No. .. 6X 4........ Lot No...��....... .
Permit No. .......... Date of Permit ..........Applicant . Emil, P. Anna, AiPpeX�, , , , , , , , ,
Health Dept.Approval ........................Labor Dept. Approval ........................
Underwriters Approval ........................Planning Board Approval ......................
Request for Temporary Certificate .....................Final Certificate .....X .................
Fee Submitted $.5,00,,,,,,,,,,,,,,,,,,,
Construction on above described building an, mit meets all ap licable codes and regulations.
Applicant � `
Ru o1ph Bruer, ttorney for Applicants
Rev. 10-10-78 6
_&— —Z 9T
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 5Zfs Ezzr,
number & street Municipals y
Subdivision Q Z Map No. ��� Lot (s) /o��
Name of Owners) &_z
Occupancy__2
typ e
Admitted by:
Key available,
,a it
own
:qfe—,
Accompanied by: QQ/-e,
Suffolk Co. Tax No.
Source of request Date Z_/
DWELLING: -
Type of construction 049 #stories QA)
Foundation CellarEc Crawl space
Total rooms, 1st. v� f� 2nd. F1 3rd. Fl
Bathroom(s)Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat A:O?/ Warm Air Hotwater T&,--
Fireplace(s) No. Exits Airconditioning
Domestic hotwater&,?/ 5 Type heater
Other
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
i