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Home My WebLink AboutZ-4752FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~/~ A/~/~7/~ S'Z'°'~ ~ ~q:' Street Map No.....'Y~. ....... Block No...-~.. ...... Lot No ..... ~', .......................... conforms substantially to the ..~ dated ...................... , 19.. dated ' . .... ~.,~..I...~. J.(-7, 197.~, 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 . ,.~. ~t, L: ]r/~ ~',7 ~ / ~, /~1~//~ k I ~q f~- :The certificate is issued to....~, f.s. .... .~.~ .~..k~ .~...T~ ..... .~ .~¥.:.~.:/.x! ............... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ........ -~. ......................................... HOUSE NUMBER .... Z~.~.~)..Street...~. ............. : ............................. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD 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, and submitted in triplicate 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ... ,~,~{~.~.. ~.~.., ...~.~. ~ ........ New Building .................... Old or Pre-existing Building .... .~.. .................... Vacant Land ............................ Location Of Property ..$./..~.....X..~...~..~...~...~..e.~...~...~.~.~..e..,.~..~..~..~...~.9.~..~..~Q~ ..................................... Owner Or Owners Of Property .~.~.,.....~..e...~..e...~.~.e....~.~..e...e..~.. ......................................................................... Subdivision .:-..~4..--~i.'.~.: ~:~.~ Lot No...~/...~.. .... Block No ............. House No...~.~...~..~.. Permit No ..................... Date Of Permit ........... i ........ Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........... ~ ............................ Fee Submitted $~.....0..0.. ........................... / /, Construction on above descri bed buildi ng~,~//r~,,~r~,~ts///p~a~ c~odes and regulations. App I icant/,/~/.,~/~'. ~,,,¢. ~¢. ~. ·/. .............................................. ~±l~am Wick~am, Esq., ~tty for Celeste Green Sworn to before me this ....];~..~.~..... day of ........ .~...~.~.~..~.,..~,~).~..~ ....... Notary ~blic ..........~..~j~.~,,,~ ........ County (stamp or seal) JOAN HINDERIViANN ~IOTARy PUBLIC, State of New York No. 52-690~0 QaolJfied in Suffolk County Term F~cplres March ~0, i~7~ HOUSING CODE INSPECTION August 17, 1972 490 North Sea Drive Southold, New York Tax Roll: C. Green Occupied: Summer tenant Upon request of the Southold Town Building Department I made inspection of this one story framed dwelling and found the following violations of Local Law 81, 1967 Housing Code of the Town of Southold. I began inspection at approximately 11:15 A.M. and was admitted by Mrs. C. Green and Mr. Sie~ert. Basement: Sump pump installed in floor hooked up to ~ectric outlet with extension cord - Section 528a. Kitchen: No light switch on entry to, control kitchen ~h-~~ Section 529b. Gas range - ~o shut off valve ahead of outlet et appliance - Section 508b. Front Porch: (enclosed) No light switch at point of entry to control light - Section 529b. NO Heatin~ System: Cannot be occupied as dwelling f'rOm first day of November to first day of May of following year - Section 513a. Completed this inspection at approximately 11:40 AM. EH:tle Respectfully submitted, E wa~d ~t~ndermann Inspector