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HomeMy WebLinkAboutZ-10540 t FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . . . . . Z.1•0540. . . . . Date . . . . . . . . June. 25 . . . . . . . . . . . . . . .. 19 ..8.1 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . • 865 •Horton- -Avenue • • • • • Matti•tuck• -New. •�or • House No. ' Street ' am et County Tax Map No. 1000 Section . . . . .1.41 . . . .Block . . . I. . . . . . . . . . .Lot . .24..2.. . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . .. . . . . . . . . . . . conforms substantially to the �&AuA},prior -to . . . . . . April. 2.3. . . . . . . 19 . 5?ursuant to w&g��� ��rtt�l�f��1.1a p a n c y Z 10 5 4.0 dated . Jura e. .25 . . . . . . . . . .. . . . . . . 19 A 1 , 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 . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . ... The certificate is issued to. . . . . . . . . . .T.aseph. :> . . L.eraerl.3.q , . Jr.. 4. Wf. . • • _ • . • . . _ • • (owner,jhwp-G[levantl_- of the aforesaid building. Suffolk County Department of Health Approval . . . . . A $. . . . . . . . . . . . . . . . . . .. . . . . . . . . • . . . UNDERWRITERS CERTIFICATE NO. . . . . N/.R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I wild hg P Ins Acir �- Rev. 1/81 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. Fees: ' 1. Certificate of occupancy 2. Certificate of occupancy on p4- Ung dwelling or land use 00 3. Copy of certificate of occupancy $1.00 _ Date . . .".�. 2 J . . . . . . . . New Building . . . . . . . . . . . . . Old or Pre-existing Building . .V. . . . . . Vacant Land . . . . . . . . . . . Location of Property /.1. w.C'�Y . .� ��!!' C, ,(!L • , ,Y. :� � Hou No. weer Ham/et Owner or Owners of Property C: . . . . . . County Tax Map No. 1000 Section . . .1 1 .... . . . . . Block . . . . .I . . . . . . . Lot . ! 4 . Subdivision . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . .Filed._Map No. . . . . . . . . . .Lot No. . . . . . Permit No. . . . . . . . . . . Date of Permit . . . . . . . . . .Applicant . . . . . . . . . . . . . . . . ... Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . f� Underwriters Approval . . . . . . . . . . . ... . . . . . . . . . . .Planning Board Approval . . . . . . . . . . . . . . . . . . . . . . �\ Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . . . . . . . . . . . . . . . . ... . Fee Submitted $ . .( I. . . . . . . . . . . . . . . . . . . Construction on above described building and ermit meets al ap Iicable codes and regulations. 0� Applicant . . y.� . . . . . . . . . . . Rev.10-10-78 .� V ' v ✓"" �' r /DG - lam/- -� . . TO' OF SOUT OLD PROPERTY RECORD CARD OWNER STREET VILLAGE DISTRICT SUB. LOT .. FORMER OWNER N E ACREAGE S W TYPE OF BUILDING - m . y- w� � v� W. B A�Ny 1 /) RES Z��� SEAS. VL. FARM COMM. I IND. I CB. I MISC. I Est. Mkt. Value .LAND IMP. TOTAL DATE I REMARKS GIB O �1/6 7 SaLD 0 aav ✓. WF �1 LM z � Eel sE flvr C-° AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD JV x / J� _ 7 -� Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland House Plot Tota I i M. Bldg. Fgundation i Bath - Extension �( �� l I Basement �� y� Floors Extension I r xt. Walls p S$ Interior Finish w L Extension Fire Place Heat i Porch i Roof Type h t Porch Rooms 1st Floor Breezeway Patio Rooms 2nd Floor i Garage Driveway Dormer O. B. rN BUILDING DEPARVIENT TOV,71 OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT oe Location number F< street Municipality Subdivision Map No . Lot(s) Name of Ovrner(s) .Occupancy type owner-t ant Admitted by• _�f'J,e�,,�„ �. • Accompanied by: Key available S-iiffolk Co. Tax No. Source of request Date DWELLING: Type of construction A . rstories 1 . Foundation e1.1ar Crawl .spac.e : Total rooms, 1st. Fl 2nd. Fl . .. 3rd. F1 Bathrocm(s) Toilet room(s) Porch, type Deck, type Patio, type. Breezeway Garage` T},pe Heat y 'rearm Air Hotwater" Fireplace(s) No. Exits Airconditioning or- Domestic hotwater. -.jA Type heater Other ACCESSIJRY STRUCTURES: . Garage, type const. ✓r' Storage, ,type const. Swimming pool Guest,: type const. Other VIOLATIONS: Housing Code, Chapter 52. : Location Description Art. 1 Sec. �3D� C _ Remarks: Inspected by: Date of Insp. ( , t Time star � _