HomeMy WebLinkAboutZ-7817FOM No. S
TOWN OF SOUTHOLD
BUR DING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 27.817....... Date ............. AUg ... ....... , 19.77
THIS CERTIFIES that the building located at G.00 $e ..M . LaAe . (Pv:T . RDA. Street
Map No.. xx ........ Block No. mac....... Lot Nom ... �ho-jd .. N•«Y ...........
conforms substantially to the FeD}ens o o f 11 & Qus code
b�?e� . be fare . Apr. 23 ...... 1957.. pursuant to which � o z�817ncy
i
dated ...........AU9. .9 ...... 1977-.1 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 Avelling.......................................
The certificate is issued to ,Anton .Primich........Owner. of .reenrd...............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval -P:Ce- .QT.si'1.g....................
UNDERWRITERS CERTIFICATE No. .pro-..exisUng............................
HOUSE NUMBER ....900....... Street . Goase . 0k .Lam . ( PVT .Hb)... Southold . .
................................................................................
..........
Building Inspectd
HOUSING CODE INSPECTION
August 5, 1977
900 Goose Creek Lane (Pvt. Rd.) R-1
Southold, N.Y.
Tax Roll: Anton F. Primick
Occupied: Frank J. Primick, seasonal
Upon receipt of an application for a Pre -Existing Certificate
of Occupancy, I made an inspection of this one and one-half story
building. I was admitted to building by Mrs. Primick and began
this inspection at approximately 1:15 P.M.
The dwelling is a wood framed structure. First floor contains
a kitchen and dining area, living room with fireplace, enclosed
porch, two bedrooms, and a full bathroom. Second floor has three
bedrooms and a full bathroom. Heat is furnished to all rooms on
first floor only from an oil -fired forced warm air furnace located
in full cellar of building's cement block foundation.
The following violations of the Housing Code, Chapter 52,
Town of Southold, New York, were found:
Entry - to enclosed porch, no means of controlling light
in room at point of entry, Article V, Section 52-56 B 2.
Heat - second floor unheated, heat shall be provided for
occupancy between 15th day of September and 31st day of
May of the following year.
Inspection completed at
EH:med
appr ximately 1:30 P.M.
Res' tful submitted,
dwar indermann
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 $5.00
3. Copy of certificate of occupancy $1.00
Date .... /kugJis to. At...1.9?.7...........
New Building .................... Old or Pre-existing Building ........XX............... Vacant Land ............................
Location Of Property ...... PI/,5..Gooze... Creek..Lane... (private.•Toad).....
Southold r..Dt... Y.•
Owner Or Owners Of Property .......AA Axl..,FA...Pr1ktiCh.........................................................................
Subdivision .............. XX............................................Lot No. .XX...... Block NoXXX....... House No.9-W .....
Permit No......IM I ....... Date Of Permit ..... XXX ....... Applicant ..1= ........................................................
Health Dept. Approval .....NIR................................Labor Dept. Approval......HAL..................................
Underwriters Approval ......N/?3................................Planning Board Approval .....A/.,R.
..........................
Request For Temporary Certificate ........................................ Final Certificate.....XX................................
Fee Submitted $ .:�........................
Construction on above described building and
permit rr"s all applic a cod d regulations.
ApplicantUl4_`i/.�.�..<K.�'J... .:.....
Sworn to before me this /S
S 7 � �K O .Z
—.• da of �...(............. (stamp or seal)
...... y �`�.. p
Notary Public ....... l.r. County
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