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HomeMy WebLinkAboutZ-4906 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z4906 . . . . . Date . . . . . . . . . .November. .1.7. . . . ., 19. 72 & gg�� ny ters Rd THIS CERTIFIES that the building located at Little. .P.eeonic . Bay.Rd. . . 5�reee� Map No. Nassau. Pt . Block No. . . .D. . . . . .Lot No. 41.7. . . . . .Cutchogue. R.Y... . . : . . . . conforms substantially to the a rams t f o fam 1 d e� n & Loeode bubefore ce t' c. occupancy . . . . . . .April 2.3 . . . . ., 19.57. pursuant to which l Z4g06 dated . . . . . .November . . . 17 ., 19.72, was issued, and conforms. to all of the require- of the applicable provisions of the law. The occupancy for which this certificate is issued is . . Private .one. -family.dwalling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . ,Robert. ►7.. .Krupski. .&- .Wife. Linda. . . . . Owners. . . . . . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Pre"exls.ting. . . . . . . . . . . . ... . . . . . . UNDERWRITERS CERTIFICATE No. . . pre--eXlSting . . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . HOUSE NUMBER. . (�I,5. . . . . . .Street. . .Little. Peconje, -Bay. Road.. • . . . . • . • • • . . . . . . • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector 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 triplicate 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. Date November 15 197 2 .......o..................... New Building .................... Old or Pre-existing Building ........?................. Vacant Land ............................ Location Of Property corner of. Little Peconic Bay Rd,& Haywaters Rd, Nassau Pt. P y ............ ............ ............................. Owner Or Owners Of Property Robert J. Krupski and Linda Ellen Krupski ....................................................................................................................... Sec D Nassu Pt Club Prop. 417 yy' Subdivision ................................................................Lot No. ............ Block No. ............ House No............. Permit No. ......... -,,...... Date Of Permit .........x......Applicant ............)!"N................................................. Health Dept. Approval ..... ...................................Labor Dept. Approval ................................................ Underwriters Approval ......... . ....................Planning Board Approval ...... ... ..............:.... Request For Temporary Certificate ........................................ Final Certificate ..X..................................... 5 00 Fee Submitted $ ..................................... Construction on above described building and permi X eets 'applicable codes and regulations. Applicant ...::...... ... ..... .. . . �..'.'? ?mil . ..... ....................... Gary Flanner Olsen, as Attorney Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County HOUSING CODE INSPECTION November 8 , 1972 645 Little Peconic Bay Road Cutchogue, N.Y. Subdivision: Nassau Point Club Prop. , Inc . Map 806 , Section D, Lot #417 Tax Roll: Robert J. Krupski Occupied, owner Upon request of the Southold Town Building Department I made inspection of this two story framed dwelling and found no violations of Local Law #1, Housing Code of the Town of Southold. I began inspection at approximately 3 : 55 p.m. and completed at approximately 4 :10 p.m. l ecainefflmann ubmitted, nd Inspector EH:tle �l ✓-. 7�6J�,�G ?t- o-- t �J .� sfs P7u_ owe aA-.��awl Q,G