HomeMy WebLinkAboutZ-6621FORK Na a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z6621....... Date ............. AuS............ 19.21.
THIS CERTIFIES that the building located at .W *8. Clark .Road .... _ .... _ Street
Map No. x=........ Block No... x= .... Lot No, .xxx _Southold ... N..Y.........
conforms
ms substantially to the reWrgnepts- _SPS oae f gilt'_ ci 1 �At homing, code
dated—t.80:r.Qre. April. .23, 19. 5.7. certificate of occupancy
pursuant to which C�To. 26621
dated .......... Attdust.... 8., 19..75, was issued, and conforms to all of the require -
meats of the applicable provisions of the law. The occupancy for which this certificate is
issued is Private -one •faxilly• duall4Ag•.......................................
The certificate is issued to 3stat*..of . Li)L1ian .Totten .to. ,Joseph XydALU..... Owner
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval prev. existing ....................
UNDERWRITERS CERTIFICATE No.. Aromroxistiag ............................
HOUSE NUMBER ......'+75• • • • • Street ...Claxk.Road........ Southold.........
... ...... .. .
Building Inspector
HOUSING CODE INSPECTION
August 8, 1975
#475 Clark Road
Southold, N.Y.
Tax Roll: Samuel & Lillian Totten
Unoccupied
Upon receipt of an application for a Pre -Existing Certificate
of Occupancy, I made an inspection of this one story framed
dwelling. I picked up key from Arnold Larson, realtor,
North Road, Southold, New York, and began inspection at
approximately 1:25 P.M.
The building consists of two bedrooms, a kitchen,
dining room, living room and full bathroom. Heat is
furnished to all rooms from an oil fired warm air furnace
located in crawl space of cement block foundation.
I found no violations of The Housing Code, Chapter 52,
Town of Southold, N. Y. The building and grounds are in
good condition.
Inspection completed at approximately 1:40 P.M. Key
was returned to Mr. Arnold Larson.
R ectfully sub itted,
EH:mm Edward Hindermann
Building Inspector
NOTE: Hallway light was left on as it was found.
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
or topographic features.
2. Sworn statement of owner or previous owner as to
3. Date of any housing code or safety inspection of
formation required to prepare a certificate.
lines, streets, buildings and unusual natural
use, occupancy and condition of buildings.
buildings or premises, or other pertinent in -
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 ..........1.��%. �7r1 ................
New Building ................ Addition ................ Old or Pre-existing Building ...... Vacant Land ..............
Location Of Property ir4/,.T.. i.r � s ,�JJJ
Owner Or Owners Of Propert�l4Tix..1n.1��`.&Aj.........................�...........`..........I..........................
����Lot No. Block No. House No.Q..1 Subdivision ......................... ..... ..�. ...........
Permit No ..................... Date Of Permit ....................Applicant ...........................
.......................................
HealthDept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ...... Yar,.:s .....................
c ss v
Fee Submitted $ ..... ........................
Construction on above described buildin and permit meet II licable codes and regulptions.
Sworn to before me thisn
.fJ. .t .. day of ........ Q�........ �..� (stamp or seal)
Notary Public ...............G1 ff—C&1KCounty R17PRETH ANN •IFVtltf
N))i4RY ►UDtIC, State .it New York
No. 52-R125B5j, Sotinik County
ne".Term Expires tdarLh 9, I9'116
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