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TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at .~.~. 5.0. ~ .~a. ~.t...F.0?..~..~., { ~... Street
Map No ............. Block No ....... ~....Lot No,
conforms substantially to the tkr~lir'nti~'n forTh':' .......o
dated ........... .~?..,.L...?_..~., 19.~.7. pursuant to which ~L~lh,~
dated ............ .~.~.C....2?., 19T..~. ., was issued, and conforms to all o~ the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . fa..7~. ~.V.~.?. :¢...0..~..~ ..... ff.~!?: L :,'....b.w..~.k.~? ?...~. .....................
..... ~'.:..~ ...........................................
The certificate is issued to ~ ~ ~' · V A ~4 0 U C) i~ Iq A I.
(owner,-._.
of the aforesaid building.
Suffolk County Department of Health Approval .....-~..~...--...E. ?.~.~.?!.~. ~ ..........
UNDERWRITERS CERTIFICATE No ......... ~...~..-....~?. ~..~.~.,?..6:-.. ..............
HOUSE NUMBER ....~. ,~. 5.0.... Street .... .~.~. ).Y..~..~..~.,., .~..o.~..~...~.. ! .~. ........
.............................................. N a..-~.,.: .-., ~c...<. .................
Building Inspector
HOUSING CODE INSPECTION
December 15, 1976
2450 Private Road #18 R-1
Mattituck, N. Y.
Tax Roil: Maria K. Van Oudenallen
Occupied: Owner
Upon receipt of an application for a Pre-existing Certificate
of Occupancy, I made an inspection of this one-story, partial
framed, partial masonry constructed dwelling. I picked up the
key from the Silkworth Real Estate Agency, Main Road, Mattituck,
and began this inspection at approximately 4:00 P.M.
The original pre-existing portion of this dwelling on the
west side consists of a utility room, which was formerly a one-
car garage, a living room with cathedral ceiling and balcony, and
a family room which is located over the garage area and contains
a fireplace. On the second floor level, there is also a com-
plete bathroom with shower. The easterly end of building, which
provides a front entry, was altered and added to under Building
Permit #7126Z, dated March 21, 1974, to which subsequent Certi-
ficate of Occupancy #Z6084 was issued on August 30, 1974. This
section of building contains a bedroom with a complete bath ac-
cessible from this bedroom, a dining room, kitchen, and utility
room. A portion of this section of building is constructed on
a cement block foundation with crawl space. The dining room
area is constructed on a slab, and the living room in the original
section is constructed on a slab, also. The pre-existing section
of the dwelling has heat supplied to all rooms from an oil-fired
forced warm air furnace located in the utility section of building.
The section of building that was added to and altered has heat
supplied to all rooms from an oil-fired hot water heater located
in the utility portion of this section.
The following violation of the Housing Code, Chapter 52,
Town of Southold, New York, was found:
Utility room - open electrical junction box on joists over
the doorway from the exterior to this area, Article V,
Section 52-56 A (1).
Inspection completed at approximately 4:30 P.M. Key was
returned to the Silkworth Agency.
Respectfully submitted,
Edward Hindermann
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 ar topographic features.
2. Final approval of Health Dept. of water supply and sewerage dispasal--(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 December 14, 1976
New Building ................ Addition ................ Old or Pre-existing Building ...~..~.. ......... Vacant Land ..............
Location Of Property .... ~.~.~.~.~.e~...~..~.~¥.Z..~.?~.~.~.~.~."~..C..k..Z~.~.~...~..~..~.~..~.~.~..~..~.~9~.~9.~~y, t
Owner Or Owners Of Property ..~..~.~..~....~.*.....~..~.~.~.....O..g~.c1...e..~...~.~..]...e.~....~..e...e...~.~.]f.~.e.~. ................................
Subdivision ....~../...~..: .................................................... Lot No.....~.../..~..: Block No..~.../..~..:... House No...~....~.....~
Permit No ..................... Date Of Permit .................... Applicant ..................................................................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Finczl Certificate ..~..~. .....................................
Fee Submitted $ ..~..,.QQ ......................... / p~l s a Jr
Construction on above described building ar~/l~rmit meets all o e code egulotions.
~L(z~/~ -~,'/~. k/~,~__;( Ap icant ...................................... ·
% BY: GEORGE C. STANKEVICH, ESQ.
~worn to before me this
14th day of December, 1976. tt~A ~. ~OWALS~I
............................................................ NO'rA~ FulL'c,
No 52-4524771
Notary Public Suffolk County ~o~ '~ ~tol~ cou~U d~'~' IF-. 2 C~l
.................................... C~m~i
Tax Map District 1000 Section 121 Block 4 Lot 19.