HomeMy WebLinkAboutZ-9477FORM NO. 4
TOWN OF SOUTHOLD
BUI~DI~G DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
....
Date ...... M.s.~.c..h .... ~..".f .......... , lg. !9.
THIS CERTIFIES that the building located at ...2125..Ceda-~ .Lan~ .......
Map No....2.7.5. ...... Block No ........... Lot No .......... ~. 2. .7 .-.1. 2. .8 ................
REOUIR~V&'NTS FOR ONE FAMILY DW~.LING BUILT PRIOR
conforms substantially to the ' ' -- --'
C~TIFICATE OF OCCUPANCY
· .Ap~.! .... ~.3. ........, 19.5.7.. pursuant to which ~ No.. Z947.7.
dated ...M.a.~.c.h. .... 2.7. ........., 19.7..9., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ..........
The certificate is issued to .......... .Ex..e.l. yp.' .B.,...S.~.e.w..ar..~ ..........................
(owner,~m~mm~mg~x
of the aforesaid building.
Suffolk County Department of Health Approval ....... .~..er..Eke..i.s.t. '.n.g ...............
UNDERWRITERS CERTIFICATE No. Pre-Existing
HOUSE NUMBER ...2. ? 2.5 ....... Street Cedar L.a~./.
/. / Eas~/~Ma~ion,/ New York
uilding Inspector
County Tax Number
1000-0~7-0t~-006
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ,~ ~/~)~- C~-~~
(number & street)
Subdivision ¢,'~2/~r,'~J ~,~ ~3V
Name of Owner~ ~L~/v
Occupancy /
(type)
Admitted by: ~_T~_/c
Key available
Source of request~
(Municipality)
Map No. vgd/~d- Lot(s)/,.~"'/'-/c:,~c;P'
(owner-tenant)
Accompanied by:
Suffolk Co. Tax No./~'3C~ -
DWi,LING:
Type of construction ,~OOD ~/~ #stories /
Foundation ~/~,r- ~ZOc/c Cellar~Z~ Crawl sPace ~-Z
Total rooms, 1st. F1 ~ w~3~ 2nd. FI~/~ 3rd. F1 ,,-
Bathroom~ ~ ~// Toilet room(s) ----
Porch, type ///~F~ Deck, type/~>~, Patio, type
Breezeway Garage Utility room
Type Heat ~z:z~c_ -- Warm Air -- Hotwater
Fireplace(s) /-/,..-,..v.,,?/'C,.-t'.No. Exits .,.%"4 / ~w Airconditioning
Domestic hotwater .~///~/~ Type heater z=~c;-/~
Other
ACCESSORY STRUCTURES:
Garage, type const. C~/~*F Fz~ Storage, type const.
Swimming pool Guest, type const.
/
VIOLATIONS: Housing Code, Chapter 52
Location Description , Art.
Sec.
Inspected by pate of Insp.
Time start//:~°~.~end
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
topograph ic 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.
Co
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....."--~../.~ ./Z'?..~. ~ ....... ;
New Building Old or Pre-existing Building ~ Vacant Land
Location of Property...~. g'~ ~c~..¥.~..~..~..,/, ~ ~~,~ ~~.~ ~.~).~
Hou~ No. Street Hamlet
Owner or Owners of ProperW ~ ~~,. ~. ~(.~~,~~.
County Tax Map No. 1000 Section . ~ ~ .~ ..... Block .... ~ ........ Lot../~.~
Subdivision .(~~.~~~.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 $ .~"~ ~"~..~. ..................
Applicant ........ .~.
Rev. 10-10-78
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