HomeMy WebLinkAboutZ-10174FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.... 710174 . .... - Date ...... October . ? ............... 19 80.
THIS CERTIFIES that the building .................... ........................ .
P27PO Main Road
Location of Property 55 .Village. Lane,........... Orient,. N,Y.. , , . .
House No. Street Ham ei
County Tax Map No. 1000 Section . 018......Block .05 ............ Lot .. 009 ...........
Subdivision ...............................Filed Map No. ........Lr7ott N1o. i........... .
conforms substantially to the�fperFrefre o'te�u'!N`i��rigr to
A2nri1. n7 ........ 19 57. pursuant to whiQq&AA iYit o.Occu�ancy .x,10174•
dated ...October ?............... 19 .80 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 .........
... .One-Fnmily Private Dgelling............... ........ .. .
The certificate is issued to.Ax�Q.... ................. .
(owner, tAM'M0 =MXX
of the aforesaid building.
Suffolk County Department of Health Approval ..... -.... . ........................... .
UNDERWRITERS CERTIFICATE. NO_ _ _ _ _ _ _ _ _ _ _ _ _ I -
Building Inspector . .
Rev V79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
qV 7d e) "AIX-) ;Po
Location crS J11j /,y 44 k
number & street
Subdivision Map No.
Lot(s)
Name of owner(s)�`-_, ;c r- L. <1 i-5 orU :�` A&2d
Occupancy /L -/
(type) / (owner -tenant)
Admitted by: /t�il^S .s <�LcCLF i Accompanied by: . ;AAS
/t 696� --
Key available Suffolk Co. Tax No.
Source of request/,, ljtiC� (�i2. �l/tee- Date j "�C�
DWELLING:
Type of construc
ies /L d
Foundation _ Cellar74,--j// _Crawl space
Total rooms, 1st. F 2nd. F -3 9 `"".5 3rd. Fl Vie- „
Bathroom(s) (.'/7) F &�C ?tZ�d/c_ Toilet rooms) C12/57 !_
Porch, type Zag-cO oysi� Deck, type — Patio, type
Breezeway Garage Utility roomjr
Type Heat4 Warm Air Ho twat er
Fireplace(s)`7—x}d No. Exit—
Domestic hotwater YL---sTvDe heater
Other
A_1�12
ACCESSORY STRUCTURES:
Garage, type const. "-/;yh (2g� Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description
Art.
Sec.
Remarks:
<t�1)
Inspected byi4fA ��'���/�%(,C.{&( ate of Insp. `�Lc�cFe
Time startdip .dd end
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
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
Inspector 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
installations, 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 property 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 in-
formation 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
Dote..September 26, 1980..............................................
New Building ................ Addition ................ Old or Pre-existing Building ..... X...... Vacant Land ..............
Location Of Property �,jsin Road & Village Lane, Orient 1000-018-05-009
...............................................................................................................
Wendall Tabor and Jayne Tabor, his wife
Owner Or Owners Of Property
.......................................................................................................................
Subdivision................................................................Lot No............. Block No............. House No.............
Permit No ..................... Date Of Permit ....................Applicant..................................................................
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........... Final Certificate XX
.......................................................................
Fee Submitted $ ...5.00 ................
Construction on above described buildingand a it meets all oppk9ble c and regulations.
P (/i'
Applicant '
IRVING L P E,
JR. as ttorney/agent for
Sworn to before me this Wendall Tabor and Jayne Tabor
......... day of ...September, 1980..... (stamp or seal)
Nota Public Suffolk Countyq