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Home My WebLink AboutZ-11245 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.1,1 45 2 . . . . . . . . . . Date . . . . . .October. ?. . . . . . . . . . . . . . . . 19 . 82 THIS CERTIFIES that the building s. . .M. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r Location of Property 1015 Private Rd . #9--Ford 's Rd. Southold House No. Street . Hamlet County Tax Map No. '1000 Section . . . . 08.7. . . . .Block 1 . . . . . . . . . . .Lot . . .R 1 7. . . . . . . . . . . Subdivision . . . .X. . . . . . . . . . . . . . ..Filed Map No. X . . . .Lot No. X . . . . . . Requirements for a private one-family dwelling built prior to conforms substantially to the Arpiicatitm-fur-Bwilding-PeTmit_1 eretof T%_1 fited'in-"-Office,dated, Certificate of Occupancy A p r 11 2 3 , 19 .5.? pursuant to which Bttiitiing'Pertrrit'No. .41 12 4 5 , dated . . . . . .0 c t o.b.e r . . . . . . . . . . 7 . . . 19 8 ,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 ... . . . . ... . a private one-family dwelling with accessory storage building. The certificate is issued to . . . . . . . . .Ralph E . & Anna L. Lavinia (owner,/e *,e P;tst67 l of the aforesaid building. Suffolk County Department of Health Approval . . . . . . n/a UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . P/a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev. 1/81 e 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. F ees: 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 September 14, 1982 Date . . . . . . . . . . . . . New Building . . . . . . . . . . . . . Old or Pre-existing Building . . . . . . . . . . . Vacant Land . . . . . . . . . . . . . Location of Property Private.Road . (Off South Harbor Road), . _ _ , , , . , , • , , Southold• , House No. Street Hamlet Owner or Owners of Property , • Ralph Lavinia and.. Anna Lavinia , . , , , , County Tax Map No. 1000 Section . . . .87. . . . . . . . . Block . . 1. . . . . . . . . . Lot . . .Pl0 ,17. , • , , Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . Permit No. . . . . . . . . . . Date of Permit . . . . . . . . . .Applicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . .. . . Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Pl6nn,ing Board Approval . . . . . . . . . . . . . . . . . . . . Request for Temporary Certificate . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . . . . . . . . . . . . . . . . . . Fee Submitted $ . 5. 00• , , Construction on above described building and permit meets all applicable codes regulations. P I CO. Applicant . . . . . . . . ��- .� . . . . : . . . . . . . . RaltI v is Rev.10-10-78 Qpn o2077 (.o na Lavinia V� STATE OF- NEW YORK s ss. COUNTY OF SUFFOLK: RALPH- LAVINIA -and ANNA LAVINIA, 'being duly sworn, deposes and says: That we are the owners of a, parcel of land on- .a private road off South Harbor' Road, Southold,r . New: York .(Suffolk County Tax Map No. - District 1000l Section- 8,7, Block 1; "Lot P/0 17) . We acquired this 'parcel on March 7, 1968 from-Edward H. Ford. (Liber 6315 Page' ' 461) . Located on the' property is .a one-story frame house and an attached gara'ge. which has -been used continuously as a residence since 1948. Also located on =the premises are a separate garage , and a shed. All of the buildings are in good condition and have been constructed prior to 1957.` The application is made- for the .purpose. of obtaining a . pre-existing Certificate- of Occupancy from the Building Department of the Town of Southold.. 'Ralph Lavpza • 7ha Lavinia Sworn to before meths 14th day of September, 1982... BARBAR 8ta a of New Yolk �1 Notary Public ,NotOrT.' �bnc; rY ;'::Nb:..52-46351'�0-Suffolk CoUt}ty Com.r"K,00r%-Expires March 30,19$y 'fir .i� r� 7"k•� z - . _`� a '-1 r : T - TOWN OF, T14, 00L P� e .-41 r -"OWNER; - STREET ' ' V_ 1LLAGE ` -' 'DI CT, SUB. LOT s r Sri. FORM R OWNER N _.-` ,' a ACREAGE . .. -` S - - +T -So. TYP,E.-OF.BUILDING4 f Y.. a K RES. l , � SEAS. VL. RM COMM. =�Y fND. I ..CB. 1 Misc. LAND IMP. TOTAL DATE REMARKS ' do 10 Q10 fill' AV Zq � Y Z//34 % 16. AGE BUILDING CONDITION , NEW NORMAL BELOW ABOVE " -- / Farm Acre f Value Per Acre Value Tillable 1. C r`"r a _;7A6 Tillable 21060 Tillable. Wcodland -Swampland Brushland Hou a Plo �� J �p f �YL � � Wit.• A rat i-� ` t��'a. ht, �� Yf►-Yid r� i z'"��Y♦ y'6....''i',RM � �'� ..,{A/�! ` w � sue• �`�' ��Y�I�� \ � .mc Ef ® ��--�.\i_. /�� .■�� s / MMM MEMMOMEMENIMS a rmay r�' a'A�:�.c`.•� N...t="�- "'�'�'.Y��f.Sw��.•t�y„e, mg3a^^�`o�'Si,� z sNr t`='i.3...',M' a''�_" e ; ' 'gip �■� .'DA■■■MME WMEMOMEM MENOMMEMN PAN Interior Finish" Fire Pkfce,-_ 'Rooms Ist Floor Elm -� t BUILDIi\dG DEPART1,1ENT TOVN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location number & street Punicipality Subdivision Map No. Lot(s) Name of O,.Jner(s) Occupancy typeAA owner enant Admitted by: '�'jf�_ V 6�Accompanied by:_ � Key available Suffolk Co. Tax No. Source of request aL t • Date DWELLING: Type of construction #stories Foundation �crawi space Total rooms, lst. Fl 2nd. F1 3rd. Fl .Bathrooms) q Toilet room(s)Rsveiq / , type F& v_e), Deck, type Patio type Breeze:•iay Garage Type Heat 'alarm Air ' Hotwater Fireplac.e(s) No. Exits Airconditioning Domestic hotwater Type heater Other ACCESSORI STRUCTURES: Garage, type const. Storage, type const. Swimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 Location Description JArt. Sec. Remarks: Inspected by: ��„ � / ' Date of Insp. Time start��/,fiend