HomeMy WebLinkAboutZ-10768FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date llove~bex, 10 1981
THIS CERTIFIES that the building $ ...............................................
Location of Property .~..~. 9.~...C.o..U~.~?., .Ro.a..d..~.07.,, 9..l??.n..l~.l~..~?..N.?.~..Y.o..r~. ............
House No. 33 Street 2 1 Hamlet
County Tax Map bio. ]000 Section ......... ./40. Block ........ 2. ...... Lot ...6. .............
Subdivision ............................... Filed Map No ......... Lot No ..............
Pa~t of a Dwelling built p~io~ to
conforms substantially
Ce~t[£[oate of Oooupnno7 210768
.... .A.~?..t,.l...2.,.3. ....... , 19 .~.7. pursuant to which'lt'm~alh~ l~rrn'irlr4 ......................
dated .... .~.o?..e~..b.e.l~...1.0 ........... 19 .~.1. ,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 l..
. .~..?zy...x~.,..o..n.c..~.o. 9.e.~.~.o..~..b..~..X.~ng...~..d. ~..~. 9. ~..e~..X.~...On. ~ .X..tn~. ........
The certificate is issued to .... ~..d.u.a..1~...Sp. 99.c.h.e' .a .....................................
(owner, I~l:~'~l"~flbYlff'
of the aforesaid building.
Suffolk County Department of Health Approval .... ~../R. ...................................
UNDERWRITERS CERTIFICATE NO.
C®z~J. 1.to~® ol' 0oot~m~o7 ~*¢)0¢)~1. - 2/2/6,¢ to Ed~r~z,d
Building Inspector
Rev. 1/81
Location
Subdivision
BUILDING DEPARTmeNT
TOI'~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
(number & street)
Map No.
(Municipality)
Lot(s)
Name of Ortner(s)
Occupancy /90N ~/~ 6 t ~'~'g~.
(type)
Admitted by: d~,s &~^~0,~J£ml
Key available
~AEC/DL ~tJ£LL~N(~.
(owner-tenant)
Accompanied by: Jar ~^
Suffolk Co; T~ No. f~O0~
Source of request
Date
DWELLING:
Type of construction
Foundation
Total rooms, 1st. F1
Bathroom(s)
Porch, type
Breezeway,
Type Heat
Fireplace(s) ~'£ ~r~ No. Exits
Domestic hotwater
Other ~f~ ~S
Deck, type
Garage
'Warm Air
~t'f~J~ #stories ~
Cellar '-- Crawl space ~
2nd. F1 _~ 3rd.. F1 ~7~c_
Toilet room(s) /x/~f~--
Patio, type
Utility room ~
Hotwater ~
Airconditionin~
Type heater ~
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool ~
Other
Storage, type con'st.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
· Location Description Art. Sec.
~,~ (4E~?[~~ f~z ~ occ~.%, " ~- fi3
~)
": ' , ' ,oeP&'-,, ~ ~?~" ~&~/' ' -
Remarks:~ ~ ~ -
Time start
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.
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 occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
New Building .............. Old or Pre-existingJ3uilding ............ Vacant Land .............
Location of Property .... rC .)'.~ .,..~. '~,',~:.. ,~, :':..-./. ........................ ,.,<'..;¢../... ;-...
House No. ' Street Ham/et
Owner or Owners of Property
.......... .............................
County Tax Map No. 1000 Section ..
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.
Health Dept. Approval ........................ Labor Dept. Approval .....................
Underwriters Approval ........................ Planning Board Approval .................
Request for Temporary Certificate ..................... Final Certificate ............. ~) .... ~1' ''~
Fee Submitted $
Construction on above described building and p/~it meets all applicable codes and regulationsr
Rev. 10-10-78
.......... Date of Permit .......... Applicant ..................................
I.