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TOWN OF SOUTHOLD
BUH,DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. ~..7.1 2.~. .... Date ........... J. -~. ¥. .... .~k ....., 19.7.6.
THIS CERTIFIES that the building located at . .N/.3..~:~.a~.n..~9~.d. ........... Street
Map No..xx ........ Block No. xx ....... Lot No, .. x.x... $.otltl~oJ, d.. ~;.~, ........
..... r. eaule~ents £o~ .ona~fa~y ~w~_l~i~_~_~_llO~s~l~g ~code
comorms suos~anually to the~ ' '
certificate of oeeuoaney
b~td b?fO~'. ~.. ~S ...... , ~9.~?. p~u~nt to w~i~ ~o. Zg.*~..
dated .......... ~uly..t~.~, 19.76., was issued, ~d co~oms ~ ~ of ~e req~
ments of the applicable pro~sions of the law. The occup~cy for which ~ ce~ificate ~
issued is .~$e..~2~. F.~$~Y..~.~%Dg .......................................
The certificate is issued to . .Eah~n. D....Dlcgorson .... ~er. o~..~ec~d .........
(owner, less~ or ten,t)
of the aforesaid b~lding.
S~olk County Department of Heal~ Approv~ .p~e-..ax~s~ng ....................
UNDERWRITERS CERTIFICATE No...pF~...flX~s~.~g ...........................
HOUSE NUMBER .... ~2~.~0 .... Street .... E'~in. Road .... So~thol~ .............
' ' ' ~~]~n~ ......
HOUSING CODE INSPECTION
July 14, 1976
52350 Main Road R-1
Southold, N.Y.
Tax Roil: Mahlon D. Dickerson
Vacant.
Upon receipt of an application of a Pre-existing Certificate of Occupancy,
I made an inspection of this one and one half story framed dwelling. I
admitted myself to building with a key provided by applicant and began
inspection at approximately 10:45 A.M..
The first floor consists of a kitchen, dining room, living room,
and bedroom. Second floor half story has two bedrooms and a full bath-
room. Heat is furnished to all rooms from an oil-fired, steam heat
furnace located in partial cellar of buildings poured cement, and part
stone masonry foundation. An open porch protects front entry to living
room. There are two seperate enclosed entries to kitchen at rear of
building, one also provides access to cellar.
The following violations of the Housing Code, Chapter 52, Town of
Southold were found:
Stairway:
to second floor, no means of controlling light at top~~
landing to provide safe ascent, Article II, Section
52-26 B. 3.
Bedrooms:
second floor, Southeast, lamp cord electric outlets on
baseboard. Southwest bedroom, lamp cord electric out-
lets on baseboard - wall electric outlet requires plate.
Article V, Section 52-56 A. 1.
Entr~:
two outside entries to kitchen, no means of controlling
light on entry. Article V, Section 52-56 B. 2.
A one and one half car garage is the single accessory structure
on the property. Buildings and grounds in good order. Key was re-
turned to Building Department to be picked up by applicant.
Building Inspector
EH:med
FORM NO. 6
TOWN OF $OUTHOLD
, Building Depmtment
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:
]. 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: I. 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
New. B~iJ,di~_~......;...~on ................Old or,~Pre-existing Building ....T,~. ..... Vacant Land ..............
~~- ~-./-~-~
[ocg,an Of Prope ..............
Owner Or Owners Of Property ........... ~ ...................... /. ............. ..0.~ ..........................
Subdivision ......................... ~ ................................. Lot No......~...... Block No ............. House No .............
Permit No ............ ~ Date Of Permit ........ ,~. ......... Applicant ..................................................................
Health Dept. Approval .......... ~..~ ................... Labor Dept. Approval .............. .~...:~_ .......................
Underwriters Approval ........... ~..~ .................... Planning Bo~rd Approval ..... .h./....~... .......................
Request For Temporary Certificate ........................................ Final Certificate ........ .~ ..........................
Fee Submitted $~...:....e~.. ........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ~., .,~.~ 2~.,...(~7...~.....~:
Sworn to before me this ~' ~' /,~/
.../.~.. ....... day of ..~.,./...~..~...~.. .......... ,stamp or se~,~
BOX 223 T£L. 51'~-323-25'75
ORIENT TRUCKING & CONSTRUCTION CO., INC.
ORIE~hiT, LOhiG ISLAhiD, hi, Y, 1195'7
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