HomeMy WebLinkAboutZ-10117FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No..7. fi.Q?~7 ........
Date .... .~.u.g~...t..2.8. .................. 19 .~.0.
THIS CERTIFIES that the building ................................................
Location of Property ...~..'-.07.~ .... .G~....P..e~.o.~ '.x.c..B.a.y....B.i.v..d: .,..M .a~.:[..~..c.k. .............
House No. Street Hamlet
County Tax Map No. 1000 Section . ?.~. ....... Block .... ~ .......... Lot .... q.~. ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
· r.equ, irements for. a one-family d_~elli.n.g bg~ilt, pr, ior to
conforms substantially to 'trre-~ppt/~atierrr'fux::Du~Pemri~heretof/ne-fited"/~tms-vm'~--
f,~ril 2~ ,19 57pursuant Certificate of Occupancy
........... : ............ to~,,~s~,~a-N~........... ~79.~.!7....
dated ...~:u..gna..s.~.. ~.8., .............. 19...8,0was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.... .~..~.v..~.t?..q~. ?. ~.=..i~.y...~. ?.:[.~. ~..~.g..w..Lt.h' .~.?.?.~?.o..~...~.~. ~.z~.~.g., ..............
The certificate is issued to ....L.....K.i.~.g..~?..e?..S..m~.~.h...a~..d..K..a~..1'~..e.e.n..S?..t..~.h. ............
(owner,~Y2X
of the aforesaid building.
Suffolk County Department of Health Approval ......... ~/.R. .............................
UNDERWRITERS CERTIFICATE NO ................. N./.~ .............................
Building Inspector
Rev 4/79
Location
HOUSING CODE INSPECTION REPORT
4275 Great Peconic Bay Blvd.
Laurel
(n,~mber & street)
Subdivision
Name of Ovmer(s)
Occupancy R-1
(type)
Admitted by: Mr. Smith
Key available
Source of request L. Kingsley Smith
Map No.
L. Kingsley Smith
(Municipality)
Lot(s)
Owner
(owner-tenant)
Accompanied by: Mr. Smith
Suffolk Co. Tax No. 128-3-15
Date Aug. 12, 1980
DWELLING:
Type of construction Wood
Foundation C~m~nt
Total rooms, 1st. F1
Bathroom(s) 1
Porch, type Glassed in
Breezeway Yes
Type Heat Gas, Central Warm Air X
Fireplace(s) No. Exits 3
Domestic hotwater Yes
Other Attached outside shower
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Deck, type
Garage. One Car
#stories
Cellar p~r~i~]Crawl space
2nd. FI 3rd. F1
Toilet room(s)
Patio, type
Utility room
Hotwater
Airconditionin~
Type heater Electric
One
Storage, type const.
Guest, type const.
Wood
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
No violations where found
Remarks:
Inspected by:
Curtis Horton
Date of Insp. 8/28/80
Time startlO:45 end 11:00
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 featu res.
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 occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date .... .A.~..~.~...]..2....1..~.8.0....
New Building ............ .,Old or Pre-axis'ling Building ..... ~. ...... Vacant Land .............
Location ~'tSoperty ~~.~..~?.t3~...]~. ~....~.]..lX~: ,..~..t:. r.~.t::~..~;..N..~.~...~.O.~ ............
House No. w--, Street Ham/et
Owner or Owners of Property . .['.o...]~..~.~.~...~,~..:[.t:.~...a~..~...[~..l:.~.[.~..~....~a.~.~.~. ...............
County Tax Map No. 1000 Section . .128 .......... Block ....... .~ ....... Lot ........... 1.~. · ·
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant. L .... Kingsley..Smi.~.h .&. 7.~t}~3.een
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ..... .][ .................
Fee Submitted $ .~.°..0.0 ........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant... ~.~.*..~?~.~'.~. '.~.~.~.'.~.'.~T., [~t S~.t:[~ ......................
Rev. 10-10-78 /geley
O
/~/ ":~, '""
~1~1 ? ~,~ ~ .
/.~//~~¢ ~ S~rv~or
/ Town of s~thold
GUARANTEED TO*
TITLE · R NT & ~T GO.
PROFESSI 0 HA~E Ne ~NEER &
LAND ~JRYEYOR. N.Y.E. LIC.I~845 '
RIVE:RI'lEAD, N.Y.
Suff. Co.,NY.
Scale~l"= 40'
May26,1953
NOTE ~ lee MONUMENT