HomeMy WebLinkAboutZ-6004FORM NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate O~ Occupancy
THIS CERTIFIES that the building located at .Birah .&..~eslo~d. R.o.a~... Street
conforms substantially to the o wllin ~
built Certificat~ of 0ccupa.ncy
dated ...b. eZ.o.r.?..~.v.r.~..~. ~., 19.57.. pursuant to which ~ No. Z.
dated ......... ~..t~. ~ ..... 1.%..., 1977~.., was issued, and con£orms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this cert~icate is
The certificate is issued tolames F & Anne Connors ~wners
(owner, lessee or tenant)
of the a~oresald building.
Su~olk County Department of Health Approval p.r.e.-...e.x.i..s~.:½g ....................
UNDERWRITERS CERTIFICATE No.. ~.r.e..-.e..x~.s..t.i.r~.g ............................
~+50 ~e slax~ P~
HOUSING CODE INSPECTION
July 15, 1974
#175 Birch Road-450 Westland Rd.
Southold, N. Y. R-1
Tax Roil: James F. Connors & Wf
Unoccupied
Upon receipt of application for Pre-Existing Certificate of
Occupancy I made inspection of this one story framed dwelling
and found the following violations of Chapter 52, Housing
Code, Town of Southold. I picked up key from the Lewis
Real Estate Agency, Main Road, Southold, and began inspection
at approximately 10:50 A.M.
The building consists of two bedrooms, eat-in kitchen,
living room, full bathroom, an enclosed porch on north side
and a screened-in porch on the west side of the building.
Living room ceiling is open with sleeping balcony. Heat is
furnished with centrally located floor register from warm
air furnace located in partial cellar.
Kitchen,
lamp cord outlet on baseboard in corner near
cooking range, with undercabinet light and
three-way receptical; electrical source is
wall outlet behind refrigerator. Article V,
Section 52-56, A.1.
Cellar
open junction box in crawl space attached to
floor joist under kitchen. Article V, Section
52-56 A.1.
Split rail fence beyond property boundaries in violation
of Chapter 100, Zoning Ordinance, Town of Southold, Article
III, Section 100-34 and 100-35 A.
Inspection completed at approximately 11:15 A.M. Key was
returned to Lewis Real Estate offic~
Building Inspector
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, end 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
Date,.~*-'~'"'! .~...! ...~....?....~.
New
Buildin~
Addition
................ Old or Pre-existing Building ...v~..... Vacant Land ..............
Location Of Property ...... ~../...~...~~...~.~...~....~..~,. A- ·
Owner Or Owners Of Property .....~'~ - .~....~..,......~....~...~~~
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 ........................................ Final Certificate ~X
Fee Submitted $ .~.'......~... ......................
Construction on above described building and permit/,~m~ets all.,~)~plicable c~s and regulations.
Sworn to before me/~is
....... /...~... day of~.....L/..~,.. ~,.¥. ...... (stamp or seal) (j(~_ ~-6tg C/C{/
........... .'. ...............
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