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Home My WebLink AboutZ-7469 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ;,. Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 469 . . . . . Date . . Jet.-: ,:1�i•. , .19. ?7 THIS..CERTIFIES that the building located at . ...g, ili .Lane . . . . . . . . . . . . . Street Map_No. . . . . . . . . Block No: . . .. . : . :Lot No, . . CUt(.ajag W. . .N Y. . . . . . . . 1rcma t '' 111 code rbtniconfmsusaally tothe ,. befdre s ccit .cy . da�ea ,. 19 . ?r7 pursuant .to which z746 . dated . . ." . . : Jan.'. .14. . . ., 19 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• Xa,m :ly. d11.811ing, . . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to lt4h G. . LAU90. . . . . . . .01-aler. . . . . . . . . . . . . . . . . . . . . . . . . . . (owner, lessee or tenant of the aforesaid building. Suffolk County Department of Health Approval pile" .existing . . , . . . UNDERWRITERS CERTIFICATE No. . ... . . . . . . .. . . . . . . . . . . . . . . HOUSE NUMBER . . . . .19 ? Street . . . . Skmr�1 -La bl . • • • • Gutchogue• . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . Building Ins ctor HOUSING CODE INSPECTION January 14 , 1977 1975 Skunk Lane R-1 Cutchogue, N.Y. Tax Roll : Ruth G. Lange Unoccupied Upon receipt of an application for a Pre-existing Certificate of Occupancy, I made an inspection of this one-story, wood framed dwelling. I admitted myself through the rear door entry with key I had picked up from Four Sails Realty in Cutchogue and began this inspection at approximately 1 :00 P.M. The building consists of a kitchen, an L-shaped room (com- bination living and dining room) , a laundry room which provides stairway access to the attic, three bedrooms , and a bathroom. Heat is supplied to all rooms from an oil=fired, warm air furnace located in the full cellar of building ' s cement block foundation. I found no violations of the Housing Code, Chapter 52 , Town of Southold, New York. Inspection was completed at approximately 1:25 P.M. and the key was returned to the Four Sails Realty office. R pectfully ubmitted, ward Hin ermann Building Inspector EH:med FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 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. 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 .ti7aA14&rY.. ......... New Building ................ Addition ................ Old or Pre-existing Building ...X.......... Vacant Land .............. N.Y. Location Of Property Eaatar1y...1irLe..mE...Bay...Ave_..... f. Co Owner Or Owners Of Property ......Ruth..G.....Lailge.................................................................................. Subdivision .......... ....................................................Lot No. ............ Block No. ............ House No........ Permit No. .....................Date Of Permit ................ :Applicant .. .................... ...................................... HealthDept. Approval ............................................Labor Dept. Approval ................................................ UnderwritersApproval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....................................... .. Fee Submitted $ ....... .5,.Q.R..........I....... Construction on above described building and permi m is I pli le es nd ulations. Applicant .............. .............. m / Sworn to before me this -moo yG. ...1?th day of .... anAMY'A 7,7........... (stamp or seaq Z y Notary!Public ...........Su f fo1.k........ County BARBARA DIACHUN to Notary Public, State of New York p(11rUG�� r�J No. 52.4635190 Suffolk County Commission Expires March 30, 1979 � II -7r S?`gyp'' i 1 .LIJ b a A2CI71Cti}-"- UVAUiNJC G - SECT:CN Tr9 G 'tOi�:.STATE-i_ AT- i _ - _ l:• i- D Cs i.:. 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