HomeMy WebLinkAboutZ-6864FOBS! NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
No. Z.6864 ...... Date . . Januar.y..27., ............. , 19.. Y.6
THIS CERTIFIES that the building located at .. N/S. PAne. Rd ............ Street
Southold, N. Y.
Map No...XX ....... Block No...XX ...... Lot No ..... XX ...........................
requirements for one family dwelling &Housing Code
conforms substantially to the
built before Certificate of Occupancy
dated ... April..2.3, ........ , 19.. 57 pursuant to which ~l~~ No. z6864..
dated ·.- J~nuar.y .27., ....... , 19.76., 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 -Privat. e. one. f~mity .dwe.l. ling .......................................
The certificate is issued to ... Elizabe.th. ~i...Cech ................................
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval .P. re.-~xi~.t, ing .....................
UNDERWRITERS CERTIFICATE No .......... Pr.e.-.~gi.s.~$.ng .....................
HOUSE NUMBER ...3 7 5 ........ Street . Pine. goad.,...S.Q .u.tho. 1..d,..N.,..Y... ........
./
HOUSING CODE INSPECTION
January 26, 1976
375 Pine Road R-1
Southold, N.Y.
Tax Roil: Elizabeth M. Cech
unoccupied
Upon receipt of an application for a Pre-Existing Certificate
of Occupancy I made an inspection of this one story framed
dwelling. I picked up key from A. W. Albertson, Real Estate
Main Road, Southold, and began inspection at aproximately
2;30 P. M.
The building consists of two bedrooms, living room, full bath,
and kitchen. Heat is furnished to all rooms from an oil fired
steam heat furnace located in full cellar. A breezeway and
one car garage is attached to east side of building. This was
added under Building Permit #2868Z to which subsequent Certificate
of Occupancy #Z2557 was issued by the Builbing Inspector, Town
of Southold.
The following violations of The Housing Code, Chapter 52, Town
of Southold were found.
KITCHEN:-
Entry - no means of controlling ~ight
in room on entry. Art V - Sec. 52-56
B2.
Gas cooking range - no shut off valve
at unit. Art. V - Sec. 52-52 B2.
Inspection completed at aproximately 3:05 P. M. - key was
returned to A. W. Albertson at his office.
Re_~ectful~ Submitted
Building
& Housing Inspector
FORM ~0. 6
TOWN OF SOUTHOLD
, Building Depor~ment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
^. 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:
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
New B~ilding ................ Addition ................ Old or Pre-existing Building ...Z..Z..~ ....... Vacant Land ..............
Location Of Property ...... ~./..S....~.~.~...~....~..a..d....~.....S..~...~.~"~..~.~..d..~..~.~......~.~..... ......................................................
Owner Or Owners Of Property ....... ~;~.~.;~b.e,~;~..~^...C,~ .......................................................................
Subdivision .......... .-...=.-...-..':=.=.~..~.m.-,.-..T,.= .................... Lot No.-..-.~,..-.,m'; Block Nor.-...-**':==-House No...3~.5...
Permit No...~(X. ............ Date Of Permit ..~'X, ............ Applicant ~X~.X~ ...................................................
Health Dept. Approval ....... tg./.~. ............................. Labor Dept. Approval ............. ~/.~, ...........................
Underwriters Approval ......... ~]~.~ ............................. Planning Board Approval ........ [~/.~, .........................
Request For Temporary Certificate ........................................ Fino, I Certificate .......... .~ ........................
Fee Submitted $ 5..00 ...........................
Construction on above described building and per~meets/~?~,~ //,,f~--~/~"P~ and regulations.
Applicant
Sworn to before me this /,/
............... day of ............................................ (stamp or seal)
Notary Public .................................... C~n~