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Home My WebLink AboutZ-5192No. Z 5192 ...... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date ..... ........JIM...13.... , 19.73 THIS CERTIFIES that the building located at R,0*W....Wfg. Bay. Ave ...... Street Map No. 7= ........ Block No... X= .... Lot No. =(.,!. UUMAX .. NAX-........... conforms substantially to the hvm J�t l . bo ore..April- .23..., 19.57. ie er ,�.. code occupancy dated ....... J.une ...1.3 ....... 1973.. , 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 . Pri.vate..orte. Xamily. .4WAIling ...................................... . The certificate is issued to .Andrew. & Jose-phine. Rudolph • • • • Viers .... ..... . ( owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -Pre.-. -existing .................... UNDERWRITERS CERTIFICATE No. pra i.. existing ................................. HOUSE NUMBER ... 1.960 ...... Street.R90...We . off Bay. Ave ........................... TXceptions . to..housing . C,ode s ................................................... 1• leo shutoff at kitchen gas stove 508b 2. Cellars leak at fuel oil tank valve 536b Gas water heater not properly vented to exterior 52oc jury rigged electric connection to water pump 528a C.A. .... Building Inspector HOUSING CODE INSPECTION June 12, 1973 #1960 Pvt. Road off Bay Ave. Mattituck, N.Y. Tax Roll: Andrew J. Rudolph and wife 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, Town of Southold. I picked up key from Val Stype Real Estate office and began inspection at approximately 1:15 p.m. Kitchen: Gas range, no shutoff valve at unit - Section 508b. Cellar: Fuel oil tank, slight leaking at shutoff valve and supply line to furnace - Section 536b. Gas hot water heater, not connected to chimney - Section 520c. Water pump electrical connection to motor, pig tail to outlet - Section 528a, e. Inspection completed at approximately 1:45 p.m. and key was returned to the Val Stype Agency. Respectfully submitted, Edward Hindermann Building Inspector EH:tle 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 V 3. Copy of certificate of occupancy $1.00 i ware ..:..f...:.1.f..::.... ................. ......... New Building .................... Old or Pre-existing Building ............................ Vacant Land .................. SFJ- ........ Location Of Property Rl�RIG A A v� ikT"T/Tc) K n..............................A.... ....Fr.....?....�.....I?....... �................ G.................... Owner Or Owners Of Property AN,�2Er,/1� k'C: o • f f% J0,! 91A/� I -AS %/(%FE PY................................................................................./..............�%....�. Subdivision ..=s. •....,..,..,•,,,,,,,, Lot No. B,Cbck No. House No....../ ............ ...... Permit No ..................... Date Of Permit ....................Applicant.................................................................. Health Dept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval ..Y :.............................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ......a ............................. Construction on above described A licant PP ••• Sworn to before me this ............... day of ............................................ Notary Public .................................... County /Yv�i/ ✓,<:.-<./(�! 1.-vyC` it meets olWlicable codes and regulations. ............ .....-.1 ...... TiiT�.T..i. .i S{............................ . roe 0W,(1kk1S A4A/A/ 20AJ), MA7_7i7()c6 (stamp or seal) z `�� S 2- 6, – m r _ .0 � R S S I •f T'tL.. ♦ ..1'X r X Wil.. M°TJ•C-Y� A^'_:fi4 .� '4M'w ..:. d 07 { i1 M cr .�7 -Cl r^ e i K � W i � v r AT* A4'..4 T T T _ r s. 4+�rE9,a+;•Tl�yf G� �i n• dz 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: V 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....1/ 3 ................ New Building .................... Old or Pre-existing Building ... ....................... Vacant Land ............................ Location Of Property R Ivc�i �1: ko af'F . �!I! �............................�......................................... Owner Or Owners Of Property�J kvWl-Pk1 `Jaj Pj /l j�rWIS Wltr .......................................................................... ............... Subdivision................................................................Lot No............. Block No............. House No............. Permit No ..................... Date Of Permit ....................Applicant.................................................................. Health Dept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval:................................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....! 1 Construction on above described building ermit meet opplicableAycodes and regulations. Applica.. . .. ..... . '�?Y.......................................... �o d2 Sworn to before me this Maw PO 0 b AA A T T t Tot K ✓�` I � ; y, , 3 ................ day of ............................................ (J- �((oo (stgmp or b seal) C Notary Public .................................... County �. )q C6