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Home My WebLink AboutZ-8995FOKM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z.0~9~. ..... Date ,. THIS CERTZFIES that the building located at .675....P~.. :. R.d.:..~. ........ Street Map No ............. Block No ........... Lot No. REOU~S FOR ON~ 'FJ~'~/,¥' ~.t;l~l' ~tlLT' I~[EFORE conforms substantially to the Cl~TIFICA~E OF OCCUP dated .. AP.I~.!! .... 23 ........ , 19.57. pursuant to whichl~t~/~l~l~No, .Z..8~.. dated .. Apt. il .... 26 ......... , 1978.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ,. I~iIVA~E .ONE .F.~IILY. DifELLII~ ..................................... The certificate is issued to Lawrence B. Do~ & wf. (owner, ~t ) of the aforesaid building. Suffolk County Department of Health Approval ....... .1~..e.-...]~..8.~.../~. ............... UNDERWRITERS CERTIFICATE No ................ . .I~..e.-..E~....~.t..t~.g .............. HOUSE NUMBER ... 675 ....... Street ....PA~t..... .BO.ad..~..5..(.B$.c.k...L~n...e.). .......... Building Inspector Housing Code Inspection April 24, 1978 675 Pvt. Rd. #5 (Back Lane) R-1 Orient, N.Y. Tax Roll: Lawrence B. Dorman & wf. unoccupied Upon receipt of an application for a Pre-Existing Certificate of Occupancy I made an inspection of the buildings on this premises. I was admitted to dwelling by Mrs. Stuart Dorman who accompanied me during the early part of this inspection that began at approxi- mately 9:20 A.M. This dwelling is a two story partial one story wood framed structure constructed on a concrete slab. First floor contains a kitchen, full bathroom, bedroom, and living room. Second floor has two bedrooms and a full bathroom. A screened enclosed porch is located on westerly side of building. One story section of dwelling was constructed on cement block piers. Heat is furnished to building from a gas fired free standing warm air heater located at southerly side of living room. Adjacent to southerly entry i.s a utility room housing a gas fired domestic hotwater heater. A hot- water radiator in second floor bathroom is connected to this unit to furnish heat to bathroom in addition to furnishing hotwater to plumbing fixtures in dwelling. A wood framed three car garage is located in front yard area. The following violations of the Housing Code, Chapter 52, Code of the Town of Southold were found: Bathroom-second floor, radiator conneoted to domestic water supply system. Article V, Section 52-51 Gas cookin~ range-no shut off valve at unit. Article V, Section 52-52 B.2. Bathroom-first floor, no moisture resistant floor covering. Article II, Section 52-26 A.4. Gas fired space heater-no shut off valve at unit. Article V, Section 52-52 B.2, Electrical-lamp cord outlet on baseboard near door of closet under stairway to second floor. Article V, Section 52-56 A.1. Foundation-under one story portion of dwelling, open on north side. Article VI, Section 52-63 B. Inspection completed at approximately 10:00 A.M. Respectfully submitted, EDWARD HI~DERMANN Building Inspector FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFICATE OF OGGUPANCY 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, o-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. Swam 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 parflnent 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 ~- I ~'- 7d~ . New Bt4ilding ................ Addition ................ Old or Pre-existing Building ..... ..~, ....... Vacant Land .............. Location Of Property ~gl¥~r~ ~'~.0.~ ~.~£a/~_~ ~-..~.. ~9F' ~9~rr~=ff=- O Owner Or Owners Of Prnnertv /-R..~'..~..~...R~...C.~ ..d~... ~ .J..,~...,~.. ~..,~A~',e~',~,~' ~"" ' ......... Subdivision -..~tf./r....~..-°.-..~..l'~t,~/A~..~./...~.....Lot No...~..P..~../~.~ Block No......~. ..... House No.....~.. ...... Permit No ........ ~ ......... Date Of Permit .......... .'T. ........ Applicant ..... ..~...r~..~..&r..................~ ............................................ Health Dept. Approval .............. ~ .......................... Labor Dept. Approval ............ -~. ................................... Underwriters Approval .................... ~ ...................... Planning Board Approval ~ Request For Temporary Certificate ..........~ ............................. Fined Certificate .......................................... Fee Submitted $ .......f..,.~.~. .................. Construction on above described building ancO_per,mit meets all opp~,~able codes and regulations. Applicant Sworn to before me this ~'~'~ 7~a~'~ .(stamp or sea ) ~. ~ NOTA.~ Ft ;I; :".'iL ': :;:!W YORK Notary Publi~ ,t