HomeMy WebLinkAboutZ-6113FO~M NO. 4
TO~ OF SOUTHOLD
B~ffL~I~G DEPAI~T~T
Tow~ Clerk's O~iee
$outholcl, N. Y.
Certificate Of Occupancy "
No. Z6~$3 ...... Date ............ Sept?. 16... 19~.
THIS CERTIFIES that the build~ located at B~yehol,e. .l~&d..~ ........... Street
Map No$~,. Ray.El$1ock No ........... Lot No.l~t~.~2t~3.
...
conforms substantially to c ode
~t. befo.l~e. Ap~:ll. ~;..19.~. pursuant to
, .....
· /~ orms to .a~l o~ the ~equi~e-
dated ........ ~ep~ ... ~6 .... , ~+.., was ~ssued, and co~
ments o~ the applicable p~ovisians~o~ the law. The occupan~fo~ which thJ~ ce~t~icate is
issued is ...Pr£wtte..~me. Zm~t3~..~Zl~nl ............//.., .........................
The certificate is issued to . C~..A,.
of the aforesaid building.
Suffolk County Department of Health Approval 1~' ~ '~/ ...................
UNDERWRITERS CERTIFICATE No. ~. e~.~t~ ............................
HOUSE NUMBER. ~ t~+~ ........ Street .B&y~o~e..l~d ..........................
lessee or tenant)
Building~ In.~pector I
HOUSING CODE INSPECTION
September 16, 1974
Sub.
Tax Roll:
Occupied:
#1445 Bayshore Road, R-1
Greenport, N.Y.
Division: Peconic ~h~T~s, Map #1124
lots 22-23 & Southerly 15' of 21
Carol A. Bolger
Owner
Upon receipt of application for Pre-Existing Certificate
of Occupancy, I made an inspection of this partial one and one-
half story framed dwelling and found the following violations
of Housing Code, Chapter 52, Town of Southold.
I was admitted to building by Mrs. Bolger and began my
inspection at approximately 10:20 A.M.
The first floor consists of a kitchen, living room, en-
closed porch, bedroom, full bathroom and a toilet room off the
bedroom.
Kitchen-.
gas range and gas oven, (built in units), no
shut off valves at units. Art. V, Sec. 52-52-
B.2.
The second floor consists of two bedrooms and full bath-
room. Heat is furnished to all rooms on first and second floors
from an oil fired steam furnace located in utility room connecting
a two car garage and dwelling.
Building exterior and open yard area in very good condition,
and well maintained.
Inspection completed
at approximately~:55 A.M.
Re~ec/~fy submitted,
Housing Inspector
FO]EM NO. 6
TOWH OF SOUTHOLD
Building Deportment
Town Clerks Office
$outhold, 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 disposol--(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 $1.00
Date ....~..e.p.~ .e. ~ .~..e..~....]:..3..:.....1. ~.?..?
New Building ................ Addition ................ Old or Pre-existing Building ..... .~.. ........ Vacant land ..............
Location Of Property ~.~.~.~.h.~.a..m.p.~m.p~q.q~.e.z~.~-~..v~.`~.~[.~$~.~.~.~..h.~.~.~.d~ ..........................................................
Owner Or Owners Of Property ..... .C.D.~.o..~...~.........~..o...]:.D..e..r.. .............................................................................
23 and S'ly 15' of 21
Subdivision ..~..e...q.o...~..J:..q...~..~7....~..s...~.~.~.e...~. ................. Lot No..22/..... 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 ........................................ Final Certificate ..........................................
Fee Submitted $ ...~..~..0..0. ........................
Construction on above described building and permit me~ al~~es~.,a ,nd r~gulations.
Applicant .................... ~ ...... ~/ ......... ~..~ ..........
Carol A. Bolger by Lefferts P. Edson, Attorney
Sworn to before me this
day of .....
Notary Public .......~.~.~ ~.o..~. ........... County
I~OTARY PUBLIC, S~e of New Y. rio
No. S2-3203050 . Suffolk Coumty'
~:ornrnission Expires March 30j
(stamp or seal