HomeMy WebLinkAboutZ-10510FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No..Z J.0.5. ! .0 .......... Date ....... ~Iune..2 ................... 19 ~l
THIS CERTIFIES that the building ................................................
Location of Property .... .475..B. 99.k.w./. .~.h. fi.v. 9p.u.q ~..T?.a.¥9 .l.9.r. . $ .~?.q q g. s. .8. qB .~.h.q hd. ....
House No. Street Hamlet
County Tax Map No. 1000 Section .... 61 ...... Block . ,1 ............. Lot .. 2.5 ............
Subdivision ............................... Filed Map No ......... Lot No ..............
· · · Ap~'.5,1 · 23 ........ ,19.5-7. pursuant to which Building Permit No ......................
dated J. uae. 2 ..................... 198 a., 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 .........
......... .~.~.~.~.~..n~..}!.a..~.~ .........................................................
The certificate is issued to ........ ~out;l~ol-d · G~':&nge.. .......... ~ ......................
Iowner, levee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ..... ~1tl ..................................
UNDERWRITERS CERTIFICATE NO ....... tl/lt ........................................
Rev 4/79
BUILDING DEP~LET['LENT
TOY,T; OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location
Subdivision
475 Beckwith Avenue~ Traveler Street, Southold. N.Y.
(number & s~ree~) (Municipality)
Map No. Lot(s)
Name of O~mer(s) Southold Grange
Occupancy
Admitted by:
B-1
(type)
Mr. Wahlen
Tenant
{owner-tenm',t)
Accompanied by: Mr. Wahl
Key available__
Suffolk Co. Tax No..61-1-25
Source of request Rudolph H. Bruer'
Date April 30~ 1981
DYF~LING:
Type of construction Wood
Foundation Brick & Cement B~ar
Total rooms, let. Fi g 2nd. FI
Full
#stories 2
Crawl space
_B~ m
Bathroom(s)
Porch, type
Breezeway
~ype Heat ~] F~re~
Fireplace(s)
Domestic hotwater Yes
Other
Toilet room(s) 2
Deck, type Patio, type__
Garage. Utility room~
'Warm Air X ' Hotwater
No. Exits ~ Airconditioning
Type heater Gas
ACCESSORY STRUCTURES:
.Garage, type const.
Swimming pool
Other
NONE
Sto~age, type ~onst.
Guest, type Const.
VIOLATIONS: Housing Code, Chapter 52
..Location I Desc.ription Art. Sec.
D=o=~,~=.t ~ hoc wager' heater, no ~ vented V 52-32-H!
Basement {ear exit n~ptJ]v h]ork~d II g2-28-A
Basement Stoves' have no ho~ ... V 52-32F
2nd Floor Kerosene h~f.~d, fl,~ ~+ ~'=~*ed 'to
. chimney V 52-32F
2nd Floor Rail. loose stairway TT 57,27'B
~utside Needs F~i~ting III 52-30-C
Remarks:
Inspected by: ~/~~,~,~-~/~,~-'~te of Insp.
' ' · Curtis Horton T]me start9:30
6/1/R1
end10:00,
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.¥, 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
Date ...A.~.=.i.]:...3.0.,..~..9.8.1. ......
New Building ............. Old or Pre-existing Building .... .X ....... Vacant Land .............
Location of Property . .4. ? .5..~.e..c~.w.~.~.~...Axe. .~.u.e.,...S.o.~.~.~..o.l.d. ..............................
House No. Street Ham/et
Owner or Owners of Property .S..o~.t.~.o.~.~..G.r, .a.n~.e?...[.n.c.....~.1.0.3..6. ?.a.~..=p.n.s., .o.~..~..s.b.a.n.~.~¥..
County Tax Map No. 1000 Section .... .6.L ......... Block ..... ];. ......... Lot .... 2,5, ..........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant . .S.o.~..~.o.~.c]., .G~.a.~.9 .e' .~c, .. .........
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval................. ....
x
Request for Temporary Certificate ..................... Final Certificate ..................... ~..,~
Fee Submitted $ · .5:.0.0· .......................
Construction on above described bu ildin~ r]~ee~j~s al, Jsapp~ic~ble codes and regu lations.
Applica ........................
R Southold Grange Inc.
Rev. 10-10-78
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