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Home My WebLink AboutZ-9027FO~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sou~hold, N. Y. Certificate Of Occupancy No.. Z9027 ..... Date .. May.. 22 ................. , 19. Blvd. THIS CERTIFIES that the building located at . 5.1.65.. Great. P. ec,..Bay... Street Map No ............. Block No ........... Lot No .................................. F. o F ¥ D. Wg~..!NG . BEFORE F 0 F Y D~g~. ~NG. . . conforms substantially to the J BUILT CERTIFICATE OF OCCUPANCY dated . April ... 25 ........ , 19.3.7' pursuant to which~ No. Z9027. · dated . May .... 2R ......... , 19.7.Q., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... PP~IVATE. ONE .F.~,L¥. D.~. ?,L.L.~..N.G. .................................. The certificate is issued to .... Fl.o.re~.c.e..c.~..1.s.s. 9.n ................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval ...... p~.e.-.E~..i.s..t.i.n.g ............... UNDERWRITERS CERTIFICATE No ................ P. VP.-..t~.~.s.~.~n.~ ............... HOUSE NUMBER .. 5.!65 ...... Street ....~?.e.a..~..P.e.c. 9.n.l.c...B.a.y...B.l.v.d.: ........... ......................................... .L."..ur..e!,...~:.~., ......................... Building Inspector Housing Code Inspection May 17, 1978 5165 Great Peconic Bay Blvd. R-1 Laurel, N.Y. Tax Roll: Florence Carlsson unoccupied Upon receipt of an application for a Pre-Existing Certificate of Occupancy I made an inspection of the dwelling on this premises. Accompanied by Curtis Horton, we began this inspection at approx- imately 10:15 A.M. by letting ourselves into building with key picked up from Matt Agency, Main Road, Mattituck, N.Y. This dwelling is a one and one half story wood frame structure constructed on a cement block foundation. First floor contains two bedrooms, a full bathroom, living room and kitchen. Second floor has a bedroom on west side and an unfinished room on east side used as storage area. Heat is furnished to all rooms from an oil fired forced warm air furnace located in full cellar. The following violation of the Housing Code, Chapter 52, Code of the Town of Southold, N.Y. was found: Electrical-open electrical junction box with a pigtail outlet on rafter in storage area of second floor. Article V, Section 52-56 A.1. Inspection completed at approximate/~ 10:25 A.M. Key was returned to Matt Agency. ~ .j~ ~s~f~./~ s ubmi tted, ' Building Inspector ' FORM NO. 6 TOWN OF SOUTHOLD 0 Building Depa~tment Town Cle~cs Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF OGCUPANC¥ 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 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), No~-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 $1.00 ote ..... a. .......................... New Bclilding ................ Addition ................ Old or Pre-existing Building ..... .x.. ........ Vacant Land .............. Location Of Property ....... ..~./..S.....~..e..g..~..n.j~.~.~.~.~..$~....~.~..~.~.~.~..~.~g'32~¢~s...~.~..'. ........................................ Owner Or Owners Of Property ...~.~0,Pu~ICR..I~.ART,$.q01~ .......................................................................... Subdivision ................................................................ Lot No. ............ Block No ............. House N~..]:.~.~ .... Permit No ..................... Date Of Permit .................... ,~oplicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincg Certificate .......................................... Fee Submitted $~AD.0 ............................ above described building and permit m ts all applicable cod s and r ulations. Applicant ........ Sworn to before me this Floeence Carls~on. 11 day ~ May 1978. (stamp or seal) Not_aw Public .................................... County C^aL /,%