HomeMy WebLinkAboutZ-9462FORK NO.{
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
Z9462
No. .......... I . Date .....March .... ............ . 19.79.
THIS CERTIFIES that the building located at .. 50300 Main Road
45 ' ' ' JdCkey * Cre<ek • Dr. c
Map No ............. Block No........... Lot No..................... .
conforms substantially to the OR
:[aw.....Apr.a.. 2.3......19.5.7pursuant to whitRT !IC ' E Q�'CCUPANCY
o• 29462
dated .....Marsh.. 9 .... , 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 ....PRIVATE. ONE • FAMILy. DWELLING • WITH • ACCESSORY . STRUCTURE ......
The certificate is issued to .......Gilbert H. Terry Est.
X
of the aforesaid building. (owner,
Suffolk County Department of Health Approval .............. PreTExisting .......
UNDERWRITERS CERTIFICATE No. ...................... Pre-.bcisting.......
50300 Main Ro
HOUSE NUMBER ... 45• • ....... Street .............?u.
Jockey . reek. Drive..... .
'..1d,..New. York .....
.........`.. dGlc.... ....
Building Inspector
County Tax Number
1000-070-02-015
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location O /Y1 /(D 5'' c ' �2 U7A/01_0-/V
number &street
Municipality
Subdivision
Name of Owner(s)
Occupancy_
e
Map No. - Lot(s)�
owner --ten
Admitted by: F Accompanied by: �rL
Key available 1-lcro.�CL- aT aj.,l Suffolk Co. Tax No -A-000-01
Source of request - Z!i- Date %
DWELLING:
Type of constructio#stories 0&z
Foundation f�-AiE&7 ,Ulc-C,/- Cellar ?,a Crawl space?/,?&7 Z_
JN�L
Total rooms, lst. F15'/�r325 2nd. Fl 3rd. Fl --
Bathroom(a� fGk/F Fv// Toilet room(s)
Porch, type4,oc4- .F��,Deck, type Patio, type 'r
Breezeway Garage Utility room
Type Heat C��7��G. Warm Airo/L Fa,,cczb Hotwater
Fireplace(s) No. Exits Two Airconditioning
Domestic hotwater // a X/4. Type heater `7,1.
Other
ACCESSORY STRUCTURES:
Garage, type const.oNc r2 ?�j'Storage, type const.
Swimming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location
Description
Art.
Sec.
A
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Remarks: Ab 6
Inspected by: ate of Insp.
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Time start_____g&end /°•`V5 ,0-
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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
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.
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
Date ... Mdx'G11..7.,..19.7.9 .......
New Building ............. Old or Pre-existing Building ... X ....... Vacant Land .............
Location of Property .............. Main, Road, , , , _ , Sotat izolc� , , , , , ,
...................
House No. Street Hamlet
Estate or
Owner or Owners of Property............f Gilbert H....................Ter. X ..........................
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 $ 5.-.QQ........................
Construction on above described building and permit me`etj all ap a codAs and regulations. n Q
Applicant ....... �F, .. .....
Rev. 10-10.78
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