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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. .ZM3..... Date ..............Sept ... 12 ..., 19.77.
AI1{,7A/ West Front St
THIS CERTIFIES that the building located at rx.lioaa.OT. 25). Street
Map No.. xx........ Block No. .XX ......Lot No. =.... QrPA4p4F.t ..I -Y....... .
r )rpen s q rvate ne f i e 1i
conforms substantially to the Xftx
cert is to o. occupancy
buA d before. -Apr. �23 . • • • . ., 19. 57 pursuant to which No. Z788.3 . .
dated .........Sept..... 12.., 197.7., 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 privata .one..family.dwelling. ..with accessory. .garage..... • • • ... .
The certificate is issued to . Greenport . union. fxee. school. district ..... Owrer .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . pre-exl.sting ....................
UNDERWRITERS CERTIFICATE No. pre-.exist.ing ..............................
HOUSE NUMBER ......75795 • . Street ...... bIain. Road. • .Greenport• • .N,Y-r • • •
. .. .. . . .4W rA l .��. . . .
Building Inspector
HOUSING CODE INSPECTION
September 12, 1977
75795 Main Road R-1
Greenport, N.Y.
Tax Roll: Union Free School District #10
Unoccupied
Upon receipt of an application for a Pre -Existing Certificate
of Occupancy, I made an inspection of the buildings at this lo-
cation. I admitted myself to dwelling with a key provided by Mary
Mahr and began this inspection at approximately 10:20 A.M.
The dwelling is a one and one-half story wood framed structure
constructed on a rubble stone, poured concrete, and cement block
foundation. First floor contains a kitchen, dining room, two living
rooms, utility room, bathroom, and enclosed front porch. Second
floor has three bedrooms and a full bathroom. Heat is furnished
to all rooms from an oil fired hot water furnace located in partial
full cellar. Front porch is heated by two electric baseboard heating
units. Accessory building in rear yard is a wood framed three -car
garage.
The following violations of the Housing Code, Chapter 52, Town
of Southold, New York, were found:
Rear entry - utility room, no means of controlling light in
room at point of entry, Article V, Section 52-56 B 2.
Electrical wall outlet - utility room, requires plate,
Article V, Section -56 A 1.
Kitchen - no cooking range and refrigerator, Article V,
Sects n 52-57 A 1.
Broken window panes - in following rooms: southwest bedroom,
bathroom on second floor, bedroom on east side, and cellar,
Article III, Section 52-31 A, B.
Ceiling fixture - in southwest section of cellar is not working,
i3'''g ttsow not insulated, Article V, Section 52-56 A 11 2
Shingles - on northwest corner of building are broken and
missing, Article III, Section 52-30 C & Section 52-31 B.
Garage - broken and missing shingles on east, north, and west
si e of building.
Inspection completed at approximately 10:40 A.M. Key was
returned to Building Department ash' structed.
Resp c fully subrvitted,
dward Hindermann, Building Inspector
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
Date ...September 9,.,,1977
New Building ................ Addition ................ Old or Pre-existing Building ...... X...... Vacant Land ..............
Location Of Property .....Front Street; Greenport, New York
Owner Or Owners Of Property ........ Greenport Union Free School District
......................................................................ry..........
Subdivision................................................................Lot No............. Block No............. House No.l.v
PermitNo ..................... Date Of Permit ....................Applicant..................................................................
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building and permit meets /all applicable podes and regulations.
Applicont .......�C'!r(!.�LG .`�
Frederick"W. U�:rai e'r Of ict.. erk""""'
Sworn to before me this
�s iz�7
9th Se tember 1977 Nor0�%���
day of.....P................,.................... 'V41 Agy"ba (sta p or�
fpU��A C./�,' ,
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