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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-22459 Date JULY 20, 1993
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 275 DOGWOOD LANE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 54 Block 5 Lot 26
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-22459 dated JULY 20 1993
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ACCESSORY WOOD STORAGE SHED
The certificate is issued to WALTER L. GOEBEL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
9 ' ZX4 _
ui ding Inspector
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTIIOLD
HOUSING CODE INSPECTION REPORT r;
LOCATION: 275 DOGWOOD LANE SOUTHOLD, NEW 'YORK
number & street municipality
SUBDIVISION -MAP NO. LOT (s)
NAME OF OWNER (s) WALTER L. GOEBEL `
OCCUPANCY A-I RES.
(type) (owner-tenant)
ADMITTED BY: . MR. GOEBEL ACCOMPANIED BY:SAME
KEY.AVAILABLE SUFF. CO. TAX MAP NO. 1000-54-5-26
SOURCE OF REQUEST: KEVIN McLAUGHLIN, ATTY DATE: JULY 9, 1993
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES ONE # EXITS 2
FOUNDATION CEMENT'BLOCK CELLAR PIT CRAWL SPACE
TOTAL ROOMS: 1ST FLR. 5 2ND FLR. . 3RD FLR.
BATHROOM (s) 1-FULL BATH TOILET ROOM (s) UTILITY ROOM
PORCH TYPE ENCLOSEDI& HEATED DECK,' TYPE PATIO, TYPE
BREEZEWAY FIREPLACE GARAGE
DOMESTIC HOT14ATER YES . TYPE HEATER 'OFF BOILER AIRCONDITIONING
TYPE HEAT OIL WARM AIR HOTWATER II •
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. .. _ STORAGE, TYPE CONST. ACCESSORY WOOD SHED
SWIMMING POOL GUEST,- TYPE CONST.
OTHER: *NOTE: GARAGE REMOVED
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS: BP #15953 CO Z-15809 FOR ACCESSORY BUILDING
INSPECTED BY: DATE ON INSPECTION JULY 16, 1993
GARZld F H '
TIME START 9:25 END 9:45
(-.7)3 -2f,
006 WOOD L ANE 0
\\ y rjr Ink: 0 SCALE'
hG�9� � : piAE oR STAKE
' ter' ue,tast�eaa� 1
LAND
1
Unardw hed alteratlon or adcom
b b4 aunrey lost
a viagm of
SeWon 7208 d the New Yak Blab
EducWat t.aar.
the
hof dw SAW mop not bwN
f or
amboaaW NSI I n�otawvftWs aoauaend
b bea%%W truaoepy.
1 nm
OMMIM Idoatad s
herear hat . G x? 3
u,AlzAN "rE..r± .7 T
en4pereaooa hisbdWlobeay M04TGAGE TITLE GO. AS
s Prepared. and orl hls behat b tlm
1 Utle00rrtpafly apvMranangl and VE yE0 ✓UL Y' 8, i 9513 -
ferrdtrp haUhdbn Isted hereon and O T T O VV: VANto Me MSSW-M
l tul M O �a�rma not kanWmbfa -+ /
r b addtbnal ktsti -ftw orsubsequent
owfw& L/GENS�T D; LANO t'URVC YOR3
1 GRg GNPOPtT +vGw r�7.Qh _„r__
5
tis �
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iORMERI-Y
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3uR✓EYEO FOR
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MAR Y A. KEA Rte/421
te/ S
ui
o
A T
9
1` VvH5 Z- AND
N
SOUTHOL D, N 1!
W.- Do,
006 WOOD L ANE 0
\\ y rjr Ink: 0 SCALE'
hG�9� � : piAE oR STAKE
' ter' ue,tast�eaa� 1
LAND
1
Unardw hed alteratlon or adcom
b b4 aunrey lost
a viagm of
SeWon 7208 d the New Yak Blab
EducWat t.aar.
the
hof dw SAW mop not bwN
f or
amboaaW NSI I n�otawvftWs aoauaend
b bea%%W truaoepy.
1 nm
OMMIM Idoatad s
herear hat . G x? 3
u,AlzAN "rE..r± .7 T
en4pereaooa hisbdWlobeay M04TGAGE TITLE GO. AS
s Prepared. and orl hls behat b tlm
1 Utle00rrtpafly apvMranangl and VE yE0 ✓UL Y' 8, i 9513 -
ferrdtrp haUhdbn Isted hereon and O T T O VV: VANto Me MSSW-M
l tul M O �a�rma not kanWmbfa -+ /
r b addtbnal ktsti -ftw orsubsequent
owfw& L/GENS�T D; LANO t'URVC YOR3
1 GRg GNPOPtT +vGw r�7.Qh _„r__
5
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
(number & strv) (municipality
SUBDIVISION MAP NO. LOT (s)
NAME OF OWNER (s)
OCCUPANCY ,o ' !'S ,
type (owner -tenant)
ADMITTED BY:. MR , �� p j -. �° C r ACCOMPANIED BY:
KEY AVAILABLE SUFF. CO.. TAX MAP NO.—,5",V- S
SOURCE OF RE4:.LST: DATE:
DWELLING:
TYPE OF CONSTRUCTION GJJ q f%�.�,.,,,� # STORIES # E%ITS Z"
FOUNDATION CELLAR CRAWL SPACE
TOTAL ROOMS: IST FLR. 2ND FLR. 3RD FLR.
BATHROOM (s) / %�vt��; TOILET ROOM (s) UTILITY ROOM
PORCH TYPE ti/✓l_ - A DECK, TYPE PATIO, TYPE
BREEZEWAY - FIREPLACE !� GARAGE
DOMESTIC HOTWATER /E% TYPE HEATER ,; LjLpIRCONDITIONING
TYPE HEATWARM AIR HOTWATER
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. STORAGE, TYPE CONST. Af rG.y
SWIMMING POOL GUEST,.TYPE CONST.
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
REMARKS:
y
INSPECTED BY: DATE ON INSPECTION_ ////
s
TIME START END T
CONSI::NT
TO
11: PCC,F10,4
Utvner(s) Name;;)
do(ec) hereby state:
tho undersir;nc.d,
n
C,-tern y 'tor,
That the undersigned
(LJ) (arc) t1Levovincr(-,) of the premise:, in the To::7r
of Southold located at
is i�ho::•n and dcsir,nated on the Sui:
Lot o1•s
County tat map as District 1000
Section ��, L'locic a
That the undersigned (has) (have) filed, or caused to beI
fI ed, an applica-
tion in the Southcld To,,vn Building Inspector's Office for the folio
That the understned do(es) hereby give consent to the Buildin? I
Of the Town of Southold to enter upon the described 5 nspectors
p propert3•, including
an., and all buildings located thereon, to conduct such inspections as
deem necessaryx They may
with respect to the aforesaid application, includi-;g inspcct_o::s
to determine that said premises comply 1:'ith all of ttie la::•s; ordinances, rules
and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, doles
so With the
l:no:vledge and understanding that any information obtained in the cors^
eruct of
such inspections may be used as evidence in subsequent prosecutions f -
or vLo
laticns of the la%xrs, ordinances, rules or regulations o the
ern of So
Dated:Na
(sigrT re�)
(print naLne)
(side atuL•c)
(print na i i lee)
=SGS I"�T�iC76' 1�0�/