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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.V;:995....... Date ........ �'.0.Mj ...... 5......... , 19 .'73.
THIS CERTIFIES that the building located at Street
Map No. x........ Block No. . �i Wig..... Lot No. ........
Reauirerients :"o-° one 1'aip.ily di,Tel1ing & Housing code
conforms substantially to the 4-p atYlexeto-to :kItbw�ari�t_l�ist:a_ff_a��.
B -gilt bef ore Certificate of occupancy
:date&:........... 3 ..., 19.;7.. pursuant to which .a;No. Z4995. .
dated ........: i O -b .. 5 ....... 19-73. , 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 .}�ritiT�? tc� P11Q . f Ar4i? y. d ":re i.l ing.......................................
The certificate is issued to ..John .&:. Patx�a. >:.C'h eel.... .� s ................... .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . a..... ol�l.... .
UNDERWRITERS CERTIFICATE No..k2'e—:exiS J4 ..................................
HOUSE NUMBER.e = 5V ' .......Street... +. (�: 17i?L I a �........................ .
............................
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Exrertiors to hozi.s�.,`ar� coz,
ti ® ��� S:. .J '✓OIL, ,jur"'' ri", „Ct lee. tr.1 .' ?1._ �; in C.i' V}'�e?�i', r='8
2• Cel! aj.. v CgpeT3 �elee j,Une tioi:i box near hot i• -vale 1, .ti ;r
�4 3ansecur� -1. eJ..9c out Let 'box h-an.F.-Ar by cab1:a . �� £�,�. .................
.jury riF -,a i light omor EtQrk U mch %2va Buildnig Inspector
FORM W0.9
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 dispcsal—(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 February9,73
Date................................................
New Building .................... Old or Pre-existing Building ......................... Vacant Land ............................
Location Of Property...W..,A:v-QU-Me.i...'f(A4s1k1.... Rvw.X,%1"x..................................................
Owner Or Owners Of Property ..`.OHN and PAULA $CH' Key with Lewis Realtors)
............................................................. ............
Subdivision ...................................... Lot No. Block No. House No.rc�
.......................... ............ ............
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 $ ...5100
Construction on above described building an I a e d regulations.
Applicant . W 1 owner
... ,��................. ......................................
. c , meq. , arty cr
Sworn to before me this
..........5th day of ..... February , 1973
.... ...........................
(stamp or seal)
Not Public .... sufiolk County NOTARY pG, L 'NDr,,
dew Y
y,
Tern, FxPire.';��o,/, "aountY
3pr 19,�
HOUSING CODE INSPECTION
February 5, 1973
9205 Bay Avenue
Cutchogue, N.Y.
Tax Roll: John Scheel and wife
Unoccupied, R 1
Upon request of the Southold Town Building
Department I made inspection of this two story,
framed, stucco dwelling and found the following
violations of Local Law #1, Housing Code, Town
of Southold. I picked up the key at the Lewis
Real Estate office, Main Road, Southold, from
Mr. John Nickles. I arrived at this home at
approximately 1:30 p.m. and let myself into the
west entrance; my inspection began at this point.
Entrance: west side, no light switch to
control light in room on entry - Section
529b.
Kitchen: outside entrance, north side, no
light switch to control light in room on
entry - Section 529b.
Bedroom, second story: southeast room,
closet light wired with lamp cord with
wire running through wall to outlet in
bedroom - Section 528a.
Cellar (partial): Open electric junction box on
floor beam at east end of hot water tank -
Section 528a. Round outlet box hanging on end
of BX cable not secured - Section 528a. Light
over work bench wired with lamp cord and plugged
light socket type outlet - Section 528a.
I found the cellar floor flooded. A sump pump
is in a pit in the cellar floor and was not
operating. No doubt this condition occurs
with the rise of the water table.
Ccruvccras•
The building is heated with baseboard ce�ns
in every room. There are three accessory buildings
on the ground in which I found no violations. On
ascending to the second floor I found the hall light
on. I left the light in the on position. I completed
inspection at approximately .25 p.m.
Res ectfu ly mitted,
Edward Hindermann
EH:tle Building Inspector
414, m vc.
75
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