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Home My WebLink AboutZ-9559FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...~.9.5.5.9. .......... Date .................. .~.~.n..e..~.]:. r ..... 19.7.9. THIS CERTIFIES that the building ................................................ Location of Property ...6. 0. ......... .~.1. ¥.a.h. '. s...L.a.n.e.t..C.u.g .c.h.o.~[u..e~..New. Xork ......... House No. Street Hamlet County Tax Map No. ]000 Section .... ]:0..9 ..... Block ....0.2. ......... Lot.. ,0.0.6. ........... Subdivision ......... .X.X.X. .................. Filed Map No...X.X.X....:Lot No...Z..X.Z ........ Requirements for On~e~ family dwellinq builtprior conforms substantially to the ~jgll~J~r~F~Xl~i~l[KO/~X~f)bYrl~:~Y~[~dCTl~l~l~c~X Certificate of Occupancy .... .A.p.r.i. 1...2.3.,. ...... , 19.5.7. pursuant to which ]~fi~i~Xev~ No .... Rg. $59. ............ dated ............ .J.u.n.e...1.1.,. ...... 19.7. .9, 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 ......... ........... PRIVAT]~ ~ . ONE .~'AMTT,y. DkIELLIRG ................................... The certificate is issued to . .E.d.w.a.r. 4..G.a.r..ry..a.n..d..J.o.y.cg..S. 1..a.tg.r' ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... .N/.A. .................................. UNDERWRITERS CERTIFICATE NO. N/A ..... ~ii~i~ ~s~c't~; ............. to Rev 4/'/9 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancv on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date....~..~ . . .~.: .... .r-~..~. ..... New Building ............. Old or Pre-~xisti~,~ BuildJJ3_q ..... .~. .... Vacant Land .......... ~ ~/.~ f'~f)i j ~- __ ... Location of Property . ~ ............ ~Z.~.. ~.~ ................... ~.¢~U~ Hou~ No. , Jtreet ~, ~let Owner or Owners of Property .... ~~ ~,.. ~. ~.~ ~... ~ ~e~ ...... .... ..... ..... ....... .... * .......... County Tax Map No. 1000 Section Subdivision ................................. Map No ............... Lot No ............... ,ermit,o ........... .......... ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~. ................. / Fee Submitted $~.: .~-~ ...................... Construction on above described building and perrn~it meets all applicable codes and regulations. Applicant / ~'~~~ ~' ' ..... Rev 101078 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT (number & street) (Municipality) Subdivision Map No. - Lot(s) Occupancy ~--~yp e) Admitted by: (owner- Accompanied by: Key available -- Source of request ;! Suffolk Co. Tax No ·/~O Date DWELLING: Type of construction ~c;~/~ Foundation ~m~= ~/~- Cellar~r~ Total rooms, let. Fl~-z ~ 2nd. F1 ~ Bathroom(s) ~-~// Porch, type "- Breezeway Type Heat ~Z/~Z_ Fireplace(s) ~ Toilet room(s) #stories Crawl sPace~z~ 3rd. F1 Deck, type ---- Patio, type Garage ~ .- Utility room .... Warm Air Hotwatero/~ ~-Z/~ No. Exits ~ Airconditionin~ Storage, type const./~Z Guest, type const. Domestic hotwater~///~Z~2~/~/~JTyPe heater Other ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other VIOLATIONS: Housing Code, Chapter 52 Location Description , Art. Sec. ¢.5' Remarks: . Inspected by: ~~,r~ate of Insp. Time start/