HomeMy WebLinkAboutZ-6393 BFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . Zb393..... Date ............AprAl ... 4 . . . . ., 19.75
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THIS CERTIFIES that the building located at . W/S .west • Branch. veep... Stereet
Map No. xxx........ Block Noxxxx ...... Lot No.. xxx .. Matt ituck .. K. Y.........
re nem a conforms substantially to the f Cod®
built before Cer fic to of occupancy
da a ........... Spril. 23., 19..57 pursuant to which Agj Vo. Z61393' "
dated .......... April... •it..., 19.75., 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. ow really. Aw9111ng.......................................
The certificate is issued to .. •Charlotte •0!Koefe• • •to Xarjorie• •Hegeman..... owner
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval pre existing. • • • • . • • • • • • • • • • • • •
UNDERWRITERS CERTIFICATE No. pre., -existing .............................
HOUSE NUMBER .....171 Q • ... Street ... Deep . Hale. Dxive.....................
................................................................................
Building Inspe or
HOUSING CODE INSPECTION
April 4, 1975
1710 Deep Hole Drive R-1
Mattituck, New York
Tax Roll: Charlotte O'Keefe
unoccupied
Upon receipt of an application for a Pre -Existing
Certificate of Occupancy, I made an inspection of this
one story framed dwelling. I admitted myself to this
building which had been opened by a neighbor Mrs. Nash
for the purpose of making this inspection which began
at approximately 10:30 A.M.
The building consists of a bathroom, eat -in kitchen,
one bedroom, a room connecting bedroom and kitchen, and
an enclosed porch. Building was constructed on posts
and is tightly skirted. The kitchen and bathroom are
only rooms having finished walls and ceilings. There
is no central heating system or insulation - occupancy
of building seasonal. (Chapter 52, Art. V, Sec. 52-53
A-1 Amended 6/7/72.
The following violation of the Housing Code, Town
of Southold Chapter 52, was found in that the room
connecting bedroom and kitchen is being used for sleeping
quarters, no privacy provided. Art. III, Sec. 52-24 D-2
Inspection completed at approximately 10:50 A.M.
Respectfully submitted,
Eff,ward Hinder ann
Building Inspector
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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 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, 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
Date ......... pril ... .r... .......
New Building ................ Addition ................ Old or Pre-existing Building .... X......... Vacant Land ..............
Location Of Property lel/.a Deep„Hole„Drive, Mattitucks NY (seerattached survey)
(Key with Sidor Realty, Main Road, IKattituck, NYj
Owner Or Owners Of Property CHARLOTTE. O' KEEF....—to b.. MAR...ORIE..L HEGEMAN)....
Subdivision................................................................Lot No............. Block No............. House No....�..�. U
Permit No ..................... Date Of Permit .................... " KK jCL0.SjNG.;... AS..SQOA...aS...BOSS.1ble.
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ............. X...........................
Fee Submitted $ ... Q ........................
Construction on above described building and per 't meet all applicable e an r gu 0
��
Applicant . j,: •`•� /. `..`. .. . ............................
WICKHAM & LARK, P.C., attorneys for Charlotte S.
Sworn to before me this O'Keefe
2nd.... day of ..... Ur.i1.,...2.97.5............ (stamp or seal)
Notary Public ..........Suffolk......... County e7 Ob
MARY LOU t O'e of I
�,u NOTARY PUGLIC, St^.te of New York
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No. 52-1060858 Su§10:z COWUY /
Oommission Expires ►larch $0, 1Q: 17 �% //
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