HomeMy WebLinkAboutZ-9963FORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Z9965
No ..................
Date .......... I~..a.y. ?9 ................ 19 ~.0.
THIS CERTIFIES ~4t~he building ................................................
~5~5 Main Road Greenport, N.Y.
Location of Property ........................................................ ; ......
House No. Street ' Hamlet
County Tax Map No. 1000 Section 0:~5 .Block 02 .Lot 008
Subdivision ............................... Filed Map No ......... Lot No ........... ,. ·
requirements for residential and commercial b~lding
.A.p..~.~.1..2..~ ............ 19 .~.7. pursuant to which Building Permit No...Z.9.9.6.~ ..............
dated ..... .M.8.Y...29 ................ 19 .~),. , was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this Certificate is issued is . ~. ......
The certificate is issued to ..... ~.O.8~...~.....T.8.~. ? ........................................
of the aforesaid building.
Suffolk County Department of Health Approval ... N.°...R??.o.~. ?1 ............................
No Record
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev 4/79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
(number
Subdivision Map No. Lot(
Name of Owner(s)
Occupancy
(t~e)
A~itted by:
( own er ~a~u~gt )
Accompanied by: /7/~ /~-/~_
Key available
Suffolk Co. Tax No.~O-(Y~$--O Z-O0~
Source of request~ --
DWE, LLING:
Type of construction ~/~
Foundation ~/~'~7--~/aC~Cellar~Z~
Total rooms, 1st. Fi~ ~ ~ 2nd. F1 ~ 3rd. F1
Bathroom(s) ~ ~ Toilet room(s) --
Porch, t~e Deck, t~e - Patio, t~e
Breezeway Garage -- Utility room
~e Heat~ ~cg Warm Air~ ~ Hotwater
Fireplace(s) No. ~its
Domestic hotwater ~
Other
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Type heater
#stories
Crawl space~/~/
Airconditioning
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Remarks: -~ /~-~ /~4/~-~>/ ~---~ ~~,~ ~,
Inspected by: ..... ~- ~ate of Insp. ~ ~ ~/~
Time start3.'/~nd ~:~ ~.
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ~'J3~-- ~__.~.~-~L~-- /~,,~,~,~ ~,~ ~~~_~ ~.
(n~ber & street) (M~ici~ality)
Subdivision Map No. Lot (s)
Key available
Source of request.~/~///~-
Suffolk Co. Tax
Date
Type of construction ,~/~z~ ~,,'~i~ #stories~
Foundation ~l~5Y ~/dR~.~_ Cellar~7-Z Crawl space~2-'~
Total rooms, let. FI /~c~ 2nd. F1 _ · 3rd. F1 -~,~\
Bathroom(s) /vo~ Toilet room(s) ~
Porch, type - Deck, type ~ Patio, type
Breezeway Garage Utility room
Type Heat~/~7?~z__ 'Warm Air O/d 7~//~Hotwater
Fireplace(s) No. Exits Airconditioning
Domestic hotwater %/~ TYPe heater ~
/ / f
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
.,Location Description Art. Sec.
Remarks: ~...~/ / /
Inspected by: ~/~f~te of Insp.
Time start~,'l~,~ end
Bo
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 featu res.
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... ,/.~'..'~. ,~.... ,~.(./..'~ ....
New Building ............. Old or Pre-existing Building . ..~. ........ Vacant Land ....... ~.~. o
/n~ntinn nf Prnn~rtv
.................. 40'.;; ..... 'j '.; ................ ................. v ......
Owner or Owners of Property .... ~.0,~.,~,,.~...~.~. ~.~, ....................................
County Tax Map No. 1000 Section .~. ,~- ........ Block . .0..~.~, ........ Lot...0,..0. ,~. .......
Subdivision ........ .~. ....................... Filed 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 $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant