HomeMy WebLinkAboutZ-4799 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.7 .799 Date Sept 7 ,
THIS CERTIFIES that the building located at . N,/S .Pine .Neck .Road Street
Map No. .xx Block No. . .x Lot No. xxx . . .Southold • N.Y.
re. , rements f. fain 1. d el .dc ; .us. code
conforms substantially to the=,. o *•4.1 it • i i -4.4 tO 11, .t 4-4,. , l •a 44.e 4.31 s*
er ifi ate . occupancyBprior tooppursuant to which ril• 23 • • •, 19.5?. #
Z 799
dated Sept 7 , 19.72., 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 . .private. *one. family •dwelling
The certificate is issued to ii-state. "of• Henry Maydom • • ' "Owner
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Pr.—.existing
UNDERWRITERS CERTIFICATE No. . . .pre.exlsting
HOUSE NUMBER.2725 Street. pine. Neck- Road
Exception to Housing codes /
1 . No referigerator 531a
2. S/W Bedroom no Light or outlets 208b ' ` f
Front enterance- no light switch 208b Building Inspector
3.. Cellar open junction box 528a
outlet no face plate 528a
two holes in foundation 302a
HOUSING CODE INSPECTION
September 5 , 1972
2725 Pine Neck Road
Southold, New York
Tax Roll: Louise Maydom
Unoccupied
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 #1, Housing Code of the Town of Southold. I
admitted myself through the rear entrance to kitchen
where inspection began at approximately 1:30 p.m.
Kitchen - No refrigerator - Section 531a.
Bedroom - southwest - No light fixture; no
outlets - Section 208b.
Front Entrance (south) - No light switch to
control light on entry to living room.
Cellar - Open junction box - Section 528a.
Outlet without face plate - Section 528a.
Two openings in foundation - Section 302a.
Inspection completed at approximately 2 : 00 p.m.
Re e ctfully subritted,
.ward fIindermann
Inspector
EH:tle
FORM NO. a
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 dispcsol—(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
e/r72---
Dote
New Building IS
o re-existin B din (� Vacant Land
Location Of Property (btB
e 10 oa,.V / , 00712041, //'y ,
Owner Or Owners Of Property Ed ` O'3 (qcor/... . a7 c(orkv
Subdivision Lot No. lac/k No. Hoo se (No
Permit No. Date Of Permit Applicant (. Jll4iD /�C� J Jf. �l.(// !/5/-4-
Health
Health Dept. Approval Labor Dept. Approval
Underwriters Approval Planning Board Approval
Request For Temporary Certificate Final Certificate `'�
Fee Submitted $
Construction on above described building and peets I applicablic � ,coodes and regulations.
Applicant f s , fll.Z �l G .�f „,7 G-'
Sworn to before me tis IV--A.-4/ —
$ `S 7 t
e — day of . 1 i`�, 2i .,ll'.�..7� (stamp or seal)f l'/7 f y_
Notary Public ” 41. .. County - -T 6-5-Cy
JUDITH T. OKE
Notary P(L;Ir, State of New York
No. 52-C-44963 Suffolk County
Cornrnission Expires March 30, )9y
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