HomeMy WebLinkAboutZ-10731FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z10731 Date October 14 19{53.
THIS CERTIFIES that the, building .......................... · ......................
Location of Property ...4.20.0..Y. QIltn~. 0. Y.e.r~u9 ......... ~QLI.'tJtl. Q],~I~..~{}W. ~.O. 12.1~ .........
House No. Street Hamlet
County Tax Map No. 1000 Section . .5,5. ........ Block ...2 ............ Lot ...... 1.3. .........
Subdivision ............................. Filed Map No. ' .l,ot No ..............
Re~uirement. s ~or,. a..Priva~e., One=Family. D~elLtng. Bttilt,~rio~ ,to
conforms subst5ntlal[y to
.Cer, t.:kf&c.g,'~e Of Qqqupancy Z10731
· .l%pleJ..1.83 .......... , 1957. pursuant ro wmc,-a-~m,m~,~-= ~e~m~ .....................
dated .... .O.c.t.qb.e.F..1.4. ............ 198. 1.. , was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
Private One-Family Dwelling wt~h Accessory Structure(3Car Garage)
The certificate is issued to .... J. tlqll.t, ll .l~ub.:krl... [o~.ok,),~.~d~ ......................
of the aforesaid building.
Suffolk County Department of Health Approval ....N/.R. ...................................
UNDERWRITERS CERTIFICATE NO. N/R
~Juilding Inspector
Rev. 1/81
Location
BUILDING DLOAP, Tr.~NT
TOt'S! OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
4200 Youngs Avenue
Southold, New York
(number & street)
Subdivision
Map No.
(Municipality)
Lot(s).,,
Name of Ov~er(s) Judith Rubin
Occupancy R-1
(type)
Admitted by: Self
Key available Sharp Realty
Unoccupied
(owner-tenm~t)
Accompanied by:' Self
Suffolk Co. Tax No. '. 55-2~13
Source of request Gary Flanner Olsen.
Date 9/23/81
D%'~LING:
Type of construction Wood Framed #stories 2
Foundation Poured Cement Cellar Pa.rtial Crawl space Rest
Total rooms, 1st. F1 5 2nd. F1 4 ~rd. F1
Bathroom(s) 2 Toilet room(s) 1
R~ar, Wood
Porch, type Side-Roof ov~e~-~ype--- Glassed in Patio, type
Breezeway.
Type Heat 0il Fired
Fireplace(s).
Domestic hotwater
Other
Garage Utility room
Warm Air -J{o~ter-- Steam
No. Exits III Airconditioning
Yes .Type heater Gas
Wood Burner in living room
ACCESSORY STRUCTURES:
Garage, type const. Wood-3Car
Swimming pool
Other
Storage, type const.
Guest, type Const.
VIOLATIONS: Housing Code, Chapter 52
Location Description Art. Sec.
Kitchen Gas Stove no shut off V · 52-52-E6
Bath, down No Ventilation I 52-26-B-4
Front of D~elling Broken window sash III 52-30-C
Front', Rea &-Side All need repairing Iii 52-30-A
'~o~cnes
S'tairs Down Open side to stairway Ii 52-27-B
Wood Burner To close to combustible material IV 52~4~-A
3 Car Garage Needs major repairs III 52-30-A
Remarks:
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
. Town Hall
Se~thold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 installa-
tions, 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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 informa-
tion required to prepare a certificate.
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
.... .............
New Building ............. Old or Pre-existing Building ....~. ...... Vacant Land .............
Location of PropertyHouse ....'~'%~'¥~'~'~' ~' '~' 'No. ' ~-~ .... f% __~' ' ~'Street ............
Owner or Owners of Property . .~ ..~ .................................
County Tax Map No. 1000Section ....~...5~.. ...... Block ..... ~ ....... Lot ..... !3 ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval .......................
Underwriters Approval ........................ Planni, Gg Board Approval ..................
Request for Temporary Certificate ................ /..Finn, alCertificate ...~. ..... i .......
Fee Submitted $. ~. ~ .................. ~ / ..~
Construction on above de~ribed building and per~ (~et~ll ~licable cod~and regulations.
Appllcan,[ __. ~ ~/~~...~ .............
F NER O[SEN ESQ.
,.,.,o-,o-,. O. Box 38