HomeMy WebLinkAboutZ-6673I~ORM NO. ~
TOWN OF $OUTHOLD
Bu~.nING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No...~..6.7.3 ..... Date ..............
THIS CERTIFIES that the building located at .]~...~1..R.o.a.~. ........ Street
Map No....z~. ........ Block No... ~;~ ..... Lot No..~I~X ... 01'~,~lat...~ ,~... ..........
conforms substantially to th~
Bu/lt
dated ...~.;.:.°r*..~.~?.~..~. ~.., ~9. ~? p.rsuant to which :~
dated ........... .~. ~.t....~.~.., 19..7.~, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . p.~.~. ?.a.t.e...o.n~....f.a~..$.I.Z..cl.w. 9 .~..~n~.' .w~..t.l~..a.~.e.9 .s99..~r' .b..t~.l..5..~.g$ .......
The certificate is issued to . ~1,~9..~.~.e~.4 .... 0~. ...........................
of the aforesaid building.
Suffolk County Department of Health Approval
(owner, lessee or tenant)
UNDERWRITERS CERTIFICATE No. pl'~.exiat~ng ..............................
HOUSE NUMBER ....~0.7.~ ..... Street ..... .~..~. ~.o.%4[ ......0F;~.~t ..............
HOUSING CODE INSPECTION
September 11, 1975
40755 Main Road R-1
Orient New York
Tax Roil: Alice Donenfeld
Occupied: Owner
Upon request for a Pre-Existing Certificate of Occupancy,
I made an inspection of this two story framed dwelling.
I was admitted to building by Ms. Donenfeld who accompanied
me during this inspection which began at approximately
10:10 A.M.
The second floor consists of four bedrooms and one
full bathroom. There are two interior stairways to first
floor and one exterior stairway on west side of building
leading to the north bedroom.
First floor has a library, living room, dining room,
kitchen with large dining area, and a toilet room located
under stairway in front entrance hall. Heat is furnished
to all rooms from an oil fired hot water furnace located
in partial cellar. A rear porch is in the process of being
replaced by a large pantry, (replacement structure within
the size of original structure).
The following violations of the Housing Code, Chapter
52, Town of Southold, were found:
Bathroom - second floor and toilet room first
floor - floor covering not tight in the area of
toilet base. Article III, Section 52-32 D.
Entrance - east side, steps and porch floor loose
and deteriorating. Article III, Section 52-39 ~.
Interior of building in the process of being renovated.
Accessory structures in rear yard area are in fair to
good condition.
Inspection completed at approximately 10:40 A.M. Applica-
tions for Pre-Existing Certificate of Occupancy were left
with Ms. Donenfeld.
FORM NO. 6
TOWN OF $OUTHOLD
, Building Department
Town Clerks Office
Southold, hi. Y. 11971
APPLIGATION FOR GERTIFIGATE OF OGGUPAN¢¥
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:
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 Bclilding ................ Addition ................ Old or Pre-existing Building / Vacant Land
Location Of Property ..~/-~L~...~..(~.~...,......~. ~..~.../......~...:.~...;....../../...?....t?.2 ....................
Owner
Or Owners Of Property ...... ./...~=...-~....~..~..~:...~~..... ..........................................
Subdivision ......... :~ ................................................. Lot No ............. c/ Block No ............. House No..~.0..~.,.'~.
Permit No ......... .~ ......Date Of Permit ...~:~ ........... Applicant ..................................................................
Health Dept. Approval .... Y~...~ ............. Labor Dept. Approval
Underwriters Approval ...... ~.......~...~ ............. Planning Board Approval
Request For Temporary Certificate ........................................ FinaJ Certificate ......~..~... ..........................
Fee Submitted $ .....~g......; .......................
Construction on above described building and~qer.mit rf~ets al~/~ppalioable c~des and regulations.
...............................
Sworn to before me this
(stomp or seal) d~rc~, lO~f (~ Je
Iy .I ,
Term E~pires March 30, 1~