HomeMy WebLinkAboutZ-7161FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . 27.161..... Date .... August .59 .............. 19.76.
THIS CERTIFIES that the building located at 0/9. $ail0 . Bah e . R. d........ Street
Mattitvck , Ne Y.
Map No.... XL ...... Block No.. XX ...... Lot No... XX ............................
REQUIREMENTS FOR A ONE FAMILY DWELLING & housing code
conforms substantially to the
datedbuilit before 19. to which fNocojgancy
..April. 2..3 ........ 57 • pursuant , p 7
ie
dated ... August. $. , ......... , 19.76., Xas 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 . Ellett .T.. Schmitt .................................. .
( owner, It )
of the aforesaid building.
Suffolk County Department of Health Approval ...N/R ................ I ............
UNDERWRITERS CERTIFICATE No....Nn......................................
HOUSE NUMBER . 1240........ Street .8ailey.Beach. Road.,.Ym-ttituckj .N....Y.
...........................................�!:................ .............
Building Inspector
HOUSING CODE INSPECTION
August 4, 1976
1240 Bailey Beach Road
Mattituck, N.Y. R-1
Tax Roll: Ellen L. Schmitt
Occupied: Seasonal
Upon receipt of an application for a Pre-existing Certificate
of Occupancy, I made an inspection of this one-story, framed
dwelling. I was admitted to building by Ms. Schmitt and John
Early who accompanied me during this inspection which began at
approximately 1:50 P.M..
The building consists of one bedroom, full bathroom,
kitchen, and living and dining room area. Heat is furnished
to building from a gas-fired wall mounted heating unit.
Building is constructed on concrete slab. Front entry is
protected by a screened porch which runs entire width of
building.
The following violations of the Housing Code, Chapter 25,
Town of Southold were found:
Kitchen: cooking gas range - no shut off valve at unit,
Article V, Section 52-52 B 2.
Inspection completed at approximately 2:15 P.M.
tectfullygubpitted,
Edward / derman�
Building Inspector
EH:med
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 �p /
Date ..... ........zv'l.....�.7..7!�?..
New Building ................ Addition ............. Old or Pre-exis ing Building . ........../... Vacant Land ..............
Location Of Property ... .�....... in..,
.C�- .....
Owner Or Owners Of Property ... ..�... ''..//.
Subdivision................................................................Lot No............. Block No............. House No.l�<?0
Permit No. .::7= ....... Date Of Permit ....................Applicant..................................................................
Health Dept. Approval .... ,` // // .......................Labor Dept. Approval ....! .............................
Underwriters Approval ......./!�1.�— :....................Planning Board Approval ...f�! .. r....................
ll ... .
Request For Temporary Certificate ........................................ Final Certificate ...../.................................
Fee Submitted $....................................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ....x'p�- ........
... �.'...�.
................................ ..... .,..
Sworn to before me this
................ day of ............................................ (stomp or seal)fwl/
.�
Notary Public County , (q
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