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HomeMy WebLinkAboutZ-11012 FORM NO.4 -- TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . V.1.012. . . . Date . . . . . . .May. 2.7. . . . . . . . . . . . . . . . . . .. 19 82 THIS CERTIFIES that the building s. . .(.2 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Vequash Ave. Location of Pybperty .301 0.0 . . . . . . . . . . . . . .MaAn. Roa.d . . . . . . . . . . . . . . . . . , , , Cutchogue House No. Street Hamlet County Tax Map No. 1000 Section .1.02 . . . . . . . .Block . . 03 . . . . . . . . . .Lot . . QQ7. . . . . . . . . . . Subdivision . . .X . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. X . . . . . .Lot No. X. . . . . . . . . . . . Requirements for a private one-family dwelling built prior to conforms substantially to the eatic�n..fcx�iiltiixtig..pesrr�i#1�eretef �-.1i -i -t,�iis-af€ic�-dated Certificate of Occupancy April .23. . . . . . . . . . . . . 19 5.7 pursuant to which B41.4ing-Bermit No. 21 1 A.1.2 . . . . . . . . . . . . . dated . . . . . May. 2.7. . . . . . . . . . . . . : . . 19 $2 ,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. p.r.ivat.e .one.-familfl. dwelling .vi.th .acc.a�sQx'.y. .tw.o.-Cat'. 3ar�L&e.. . . . . . . . The certificate is issued to . .d9hilA4dzAl,an, &, ,wife ( Estate of Helen ^'tadzelan) (owner,1z&w-ort&aa.Q4 of the aforesaid building. Suffolk County Department of Health Approval. . . . .nlr. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . .n•!r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C� �. . . . . . . . . . . . . . . . . . . . . . . . Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOU I I-101_1) Building Department 'Crown Hall Southold, N.Y. 11911 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . . . 5�1.°�\.." -. . . . . . . . . . New Building . . . . . . . . . . . . . Old or Pre-existing Building . . . . Vacant Land . . . . . . . . . . ... . Location of Property r . . . . . :4eG� �h 1!'yye l�v-, LSO a .0 House No: St eet Owner or Owners of Property�l•t •J\ • • ��a:Ao\ � ��� �� X&(�XZ\\) County Tax Map No. 1000 Section . .� � ' '.,`_ Bloch. .'. . � . . . ..Lot,. . . . . .�:�. . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' .Map No. . . . . . . .(Ql . Lot No. X. . . . . . . . . . . . Permit No. . . . . . . . Date of Permit . . . . . . . . . .Applicant . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _. Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . .. . . . . . . . . . . . . . . . . Underwriters Approval. . . . . . . . . : . : : . .Planning Board Approval . . . . . . . . . . . . . . . . . . . . . . Request for Temporary Certificate rificate . . . . . . . . . . . . . . . . . . . . . i al Certificate . . . . . . . . . . . . . . . . . . . . . Fee Submitted $ . . . S . . . . . . . . . . . ... .. . . . . . . . . Constructi on above described building and permi ets a icable c es nd regulations. J0lilVl -Applicant . . . . . . ' . . . . . . . . . . . Rev.10-10-7$ GA FLANNER OLSEN ESQ. rrQ- 0,o. 2 1 a P. 0. Box 38 ��- :4. 0 f'o s .�� �Z Main Road Mattituck, L. L MY. 11952 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT Location 's` ,�� C/ca"7� �! c ,j number & st eet Municipal .ty Subdivision Map No. — Lot(s) Name of Owner(s) /tg 4= Occupancy , type owner-tenant Admitted by: --5Cl Accompanied by: l�cac/ Key available.�-1� � - l' c6 Suffolk Co. Tax No /� 7 Source of request Date DWELLING: Type of construction ##stories Foundation CeyY,-ne,2Z Zlbc0<. Cellar.¢ ` Crawl space Total rooms, lst. F 2nd. Fla /3�s 3rd. Fl -- � Bathro o Hc� m(s) Z Toilet rooms) 1z 1�-,-- Porch, typed --/3�,:e Deck, type — Patio, type Breezeway Garage Utility room Type Heat2G-?%Yr3/ Warm Air Fireplace(s) Q'!2C No. Exits — —Wd Aircondiiioning Domestic hotwater ��-� Type heater Other ACCESSORY STRUCTURES: � _ Garage, type const. _7k&o Ces;7�— Storage, type const. -- Swimming pool — Guest, type const. -- Other VIOLATIONS: Housing Cede, Chapter 52 Location Description ' Art. 1 Sec. ..� all .6 �l rc 5! 67��'s�I �� `7��✓N.� � S Z Z� -56 (� Remarks: 77 UP f-1 Inspected by: "L&4'gtaa� Date of Insp. �/ `file- d- Time start` dxdl