HomeMy WebLinkAboutZ-9111No. ..29111....
FORM Na s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
Date ...... Ju?Y..... 17 .......... 19 .. 78
THIS CERTIFIES that the building located at ..645, Bre2kwater Road Street
Map No ............. Block No........... Lot No................................. .
conforms substantially to the F 0 F fa a Ind
LY D JNQT BEFORE
A ril 2 CER IFICATE OF OCCUPANCY
dated ..... P....... 3 ....... , 19.57 pursuant to which M it No. Z9111•
dated ... 'T'4Y ...17 ......... 19. 78, 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 ... PRIVATE, ONE . FAMILY. DWELLING
..........................................
The certificate is issued to .......Joan L. Sullivan.......... .
( owner,
of the aforesaid building.
Suffolk County Department of Health Approval .......... Pre-:-lst�Ag ...........
UNDERWRITERS CERTIFICATE No.................... .. Pre -Existing.......... .
HOUSE NUMBER ....6....... Street ......... Breakwater Road
r-
rMattituck... .. York......... .
..... ....................
Building Inspector
Housing Code Inspection
July 14, 1978
645 Breakwater Road
Mattituck, N.Y.
Tax Roll: Joan L. Sullivan
occupied: owner
Upon receipt of an application for a Pre -Existing Certificate
of Occupancy I made an inspection of the dwelling at the above
captioned premises. I was admitted to building by Mrs. Sullivan
and began this inspection at approximately 3:15 P.M.
This building is a two story wood framed structure constructed
on a poured concrete foundation. First floor contains a rear entry
vestibule, full bathroom, kitchen, dining room, living room with
fireplace and front entry hallway. Second floor has four bedrooms,
a full bathroom and hallway with access door to attic storage area.
An open roofed over porch protects front entry to building. Heat is
furnished to all rooms fron an oil fired hotwater furnace located in
full cellar.
The following violations of the Housing Code, Chapter 52, Code
of the Town of Southold, N.Y. were found:
Electrical -ceiling fixture rear entry vestibule, pull chain
swi c bro en, Article V, Section 52-56 A.1.
Interior Protection & Structural -First floor bathroom, floor
covering at base of toi et is cracked and floor is sagged and
deformed. Article III, Section 52-30 A.B. & Section 52-32 D.
Sewage System -recent plastic soil line installation connection
was made between cesspool and house trap -also no fresh air
vent for house trap. Article V. Section 52-51 C.1-7.
Inspection completed at approximately 3:4j)—�.M.
Re ectfully s witted,
WARD HI
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Deportment
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
3. Copy of certificate of occupancy $1.00 J V L`` `{ (r%7g
Date............................... y...........
New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................
frF Location Of Property ..... fl K W AT E `�.. A 1�
.....................................................................................:.....................................
Owner Or Owners Of Property ..............cf b Q Iv S.. L V !�
....................................... ...........................................................
Subdivision................................................................Lot No............. Block No............. House No..h.
PermitNo ..................... Date Of Permit ....................Applicant..................................................................
HealthDept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
po
Fee Submitted $ ........ !.5 .
Construction on above described building and permit meets all applicable codes and regulations.
APPlicanV.,vvx.. , c.. .�.rzu...� .....................................
Sworn to before me this
................ day of ............................................ (stamp or seal)
Notary Public .................................... County ;/nh il
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