HomeMy WebLinkAboutZ-10163 FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No. . Z1.0163. . . . . . . . . - Date . . . . . September. 2.9 . . . . . . . . . . . 19 8Q
THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of Property .27.0 Pay.• A-vQn !:. . . . . . • . . . . . . . . . • Rast: Marion,. .Na Y... . . . .
House No. Street Hamlet
County Tax Map No. 1000 Section . . Q3!. . . . . .Block . . Q$ . . . . . . . . . .Lot . . 006.. . . .. . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . .. . . . . . . . . . .t.�. .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . ..
conforms substantially to the gpeircat aeiim-Pv irxffi g- ero h�cahmo _•q,e�rinl- s# �e t rior to
Certificate of Occupancy Z10163
.Apr .?.3.,. . . . . . . . . . . 19 57 pursuant to which Build4n-gPoFmit-STo-.. . . . . . . . . . . . . . . . . . . . .
dated September. 29. . . . . . . . . . . ..1980. ,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 private One
Family Dwelling with Accessory Garage-Side Yard Variance Appeal
A971. , -October. 6,. .196.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . .Frea.:da.WingertEir . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
(owner,X lessee
XXXXX WXXX
of the aforesaid building.
Suffolk County Department of Health Approval . . . .WR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . .NT/R . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.. . .. . .
Building Inspector
Rev 4/79
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Soutlhold, .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:
I s 1. Final survey of property with accurate location of all buildings, property lines, streets, and
b unusual natural or topographic features.
p�2. Final approval of Health Dept. of water supply and sewerage disposal—(S-9 form or equal).
p Approval of electrical installation from Board of Fire Underwriters.
�4. Commercial buildings; Industrial buildings, Multiple Residences and similar buildings and
SECi:^ 1 f 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:
BLOCK 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.
. Date of any housing code or safety inspection of buildings or premises, or other pertinent in-
formation required to prepare a certificate.
Fees:
totCertificate of occupancy $5.00
Certificate of occupancy on pre-existing dwelling or land use $5.00
Copy of certificate of occupancy $1A
Date ........ ...................
New Building ................ Addition ................ Old or Pre-existing Building ....�...... Vacant Land ..............
b
Location Of Property .... .!1�... )!!�r'-............ '` i`' ........ .. .. �y1��1 ............................
Owner Or Owners Of property .r a -..... A . .............. ,
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 .................................. ..... Fi al Certificate ...( ................................
Fee Submitted $ ... ...mil .................
Construction on above described building .and-.per it et applicabl . es and regulations.
Applicant ... ,. .' . .. .
Sworn to before me this GARY FUNNER �c-n ��• �0��3
day of P. �t� &of) /
...../gl� / �........ .
Notary Public .... County Main Read
laffitu¢k, L. L, N.V. 11952
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 2 O C�A` �V i`�/r<I/��p�./ /V•r.
number & street)
Municipality
Subdivision Map No. — Lot(s)
Name of Owner(s)
Occupancy
type owner-Tenant)
Admitted by:L:)/.,,Q,c%= /144 P-e H Accompanied by:
Key available Suffolk Co. Tax No. /ngno 493/
Source of request�' t(0 •- /
Date
DWELLING:
Type of construction Woo0 7FW4/..lE #s-tories-0 AI,=--
Foundation_ OF_741;c.7-.
r .3Lr)C- Cellar - Crawl space
Total rooms, 1st. Fl �° ; �`�2nd. Fl
3rd. Fl
Bathroom(s) O�z=� Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility rooc` ,L� rr✓. �_.
Type Heat_ it,T�� " Warm Air -- Hotwater p9,d_ F7// 0
Fireplace(s) No. Exits Airconditioning
Domestic hotwater Type heater,
Other
ACCESSORY STRUCTURES: ems,
Garage, type const.��/-r. iuvou ;� Storage, type const.
Swimming pool Guest, type const.
r,r �dr� -•. Ll,�//�i.�e�.-ems .�r�+� `/�i�
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. 1 Sec.
r f/cic/ � _ ,A—r/c/ /
Remarks:Davnz0 1��6 D,4 tmU
Inspected of Insp.� �/ -
�GaZY/
Time starts%/s-fb� end 5.r5o ��