HomeMy WebLinkAboutZ-8092FOB~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Cerfi~icnte O~ Occupnncy
No...~....~..O.~t..~ Date ~ c_- ~ -'/ , 19'~
THiS CERTiFiES that the buildin~ located at'))~' ' '~' ' '~. '.~'~' ~ ~b'°~ ~i
~ ...................... ~:.. Stree~
~.~o ..... ~ ..... ~o~o...~ ..... ~o~o..~ ..... ~~..~'
conforms substantially to th~~~~cr~~d ~
~ ..... ~ ......., ~9.~7
... pursuant to which B~i~g P~*"~t ~o. ~.~O~
dated ................ ~.'.~..., 19~. ~., was issued, ~d conforms to ~ of ~e req~
ments of the applicable provisions of the law. The occup~cy for which ~is certificate
T~e certificate is issued to .... ~.,.. ]~.~. ~ ~ ~. ~
of the aforesaid building.
S~olk County Departmen~ of He~th Approval ~.: ~ '/' ...............
u~awa~,~as c~a~c~ ~o. ~.... ~.~:~:~../ ...................
~ous~ ~u~a ./.~. st~t .~.~-/~ .~9.~ . .x~ ...............
Building Inspec¢or
Housing Code Inspection
December 23, 1977
150 Pvt. Rd. #2 R-1
Southold~ N.Y.
Tax Roll:
Occupied:
Dudley B. Hagerman
Betty Hagerman
Upon receipt of an application for a Pre-Existing Certificate
Of Occupancy~ I made an inspection of this one story dwelling.
I was admitted to building by Ms. Hagerman and began this in-
spection at approximately 2:30 P.M.
The building is a one story~wood frame structure constructed
on a cement block foundation and consists of two bedrooms~ a full
bathrooms kitchen and living room.
Heat is furnished to all rooms from an oil fired hotwater
furnace located in full cellar.
The following violations of the Housing Coder Chapter 52~ Code
of the Town of Southold, N.Y. were found:
Entries: front and rear~ no means of controlling light in
rooms at point of entry. Article V~ Section 52-56 B.2
Gas Cookin~ ranze: no shut off valve at unit. Article V~
Section 52-52 B.2
.SewaEe System: no house trap. Article V~ Section 52-51 C.1
Inspection completed at approximately 2:50 P.M.
~dwa~d Hindermann
Building Inspector
IPOKM NO. 8
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Southold, N. ¥. 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
Rte .....
New Building .................... Old or Pre-existing Building ...... .Z.. ................... Vacant Land ............................
Location Of Property ~R~~h~]:~/~a~~~~ ...............................
Owner Or Owners Of Property ..... .D...u..~...[..e.~....~........[-[..a.~.e....~...a..p. ......................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No...D.../..~.ff..~. ....... Date Of Permit .................... Applicant ...... D ./.~/~ ................................................
Health Dept. Approval .....D../.~./..~. ............................. Labor Dept. Approval ....... ..D.,,(.~.../..~. .............................
Underwriters Approval ..... ..D../..~./..~. ............................. Planning Board Approval .D./..~../..~. .............................
Request For Temporary Certificate ........................................ Final Certificate ........... .~.. ............................
Fee Submitted $ ..... ..5.....0...0. .....................
Construction on above described building and permit rn~e~ts ~1 ,q~pI, j~ebl, e/coc~,/a,o~ r~gulations.
App,,cant ............ = ...... .,:. ... ........
Sworn to before me th, ie~ ///-/2~/; ~/77
Notary Public .......... .S...u. ~.~ .o..1,..~. ......... County
A FOSTER
IqOTARY PUnliC, e,.,, o[ Fc;v
t!0 3'2_ 4' ~:'':', S:: f'4 ¢'I;"'
(stamp or seaI7