HomeMy WebLinkAboutZ-35720 �o�gUfFOt,�c� Town of Southold Annex 5/30/2012
�y 54375 Main Road
Southold,New York 11971
iP
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 35720 Date: 5/30/2012
THIS CERTIFIES that the structure(s) located at: 58473 Route 25, Southold
SCTM#: 473889 Sec/Block/Lot: 55.-6-33.2
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 35720
dated 5/30/2012 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one family dwelling and accessory barn.
(reinspection done 5/29/12)
NOTE:BP 34419 deck COZ-35302
The certificate is issued to Yellin, Helen&Yellin, Rachel
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. , N 285927 Barn only
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Auto ed S' atur
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 58473 Route 25, Southold
SUFF.CO.TAX MAP NO.: 55.-6-33.2 SUBDIVISION:
NAME OF OWNER(S): Yellin,Helen&Yellin,Rachel
OCCUPANCY:
ADMITTED BY: Angie Johnson
SOURCE OF REQUEST: Yellin,Helen&Yellin,Rachel DATE: 5/30/2012
DWELLING:
4
TYPE OF CONSTRUCTION: #STORIES: 2 #EXITS: 2
FOUNDATION: concrete CELLAR: CRAWL SPACE:
TOTAL ROOMS: 1ST FLR.: 2ND FLR.. 3RD FLR.:
BATHROOM(S): 2 TOILET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: yes TYPE HEATER: oil AIR CONDITIONING:
TYPE HEAT: oil WARM AIR: HOT WATER: X
#BEDROOMS: #KITCHENS: BASEMENT TYPE: full
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: Barn
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: GARYF DATE OF INSPECTION: 7/6/1993
` TIME START: 9:00am END: 4:00pm
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN HALT,
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This•application.must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new-use:
1. Final survey of property with accurate1ocation of all buildings,property lines,streets,and unusual natural or
topographic features_
2. Final Approval-from Health Dept.of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters-
4. "Swain statement from plumber certifying that the solder used-in system contains less than 2/10 of 1% lead. .
5. Commercial building.industrial building,multiple residences and similar.buildings and installations,a certificate
of Code Compliatice-from architect or engineer responsible for the building..
.6. Submit Planning Board Approval of completed site plan requirements-
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses.
1. Accurate survey of property showing all property lines,streets,building and.unusual natural or topographic
features:-
2- A properly completed application and consent to inspect signed by the applicant- If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons,therefor in writing to the applicant_
C. Fees
1. Certificaie of Occupancy- New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50-00;
f Swimming pool$50-00, Accessory building$50.00,Additions.to accessory.building$50.00, Businesses$50 00_
2- Certificate of Occupancy on Pre-existing guiiding- $100.00
3. Copy of Certificate o€:Occupancy-$25
4- Updated Certificate of Occupancy- $50.00..
• 5_ Temporary Certificate of Occupancy -Residential $15.001,Commercial$15.00
Date_ -Ohl
New Construction: Old or Pre-existing Building: l/ (check one)
Location of Property: AL,
L,f
House No. J Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No-1000,Sections Block Lot 3 a
Sabdivisioa Filed Map. Lot:
Permit No. Date of Permit: Applicant:—
Health Dept.,Approval.: Underwriters Approval:
Planning Board Approval:
Request for: Te porary Certificate Final-Certificate: (check one)-
Fee-Submit
ted:$ r/",
. 1 1
CONSENT TO INSPECTION
the undersigned, do(es)hereby state:
Own r(s)Narne(s) .
That the undersigned(is) (are)the owners)of the premises in the Town of
Southold, located atS Hut . )e rl
which is.shown and designated-on the Suffolk County Tax Map District 1 U00;
Section' Block gyp.. , Lot 3, 0,
That the.undbrsigned(has)(have)'filed,.or cause to.be filed,,,pn application-in the
Southold Town Building:Inspector's Office for-the following:
That the undersigned does)hereby give.consent to the Building Inspectors of.the
Town of Southold to enter upon the above described property, including any and all
buildings located thereon;.to conduct such.inspections.as.they may deem necessary with
respect to the aforesaid application, including inspections to.determine that said premises
complywtiloie laws ordinances,rulesdations of the Town of Southold.
The undersigned,in consenting to such inspections,.do(es) so with the knowledge
and understanding that any information obtained.in the conduct of such inspections may
:. be used insubsequent prosecutions.for violations of the laws, ordinances,rules or '
regulations.of the Town of Southold: .
Dated:
(Si afore)
Qk
(Print ame)
Vignature) .
(Print Name) . .
-THE NEW YORK BOARD OF FIRE UNDERWRITERS PAG 1
1001071
'� \I 1 BUREAU OF ELECTRICITY
) l 85 JOHN STREET, NEW YORK. NEW YORK 10038
Date AUG Ur-Tl 1,4\,}1)9,a, Application No.onfile 0n84939`'/93 N 2t459 7
(- i --
THIS CERTIFIES�T1-IAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
PAT t-OONEY, ROUTE 25, SOUTHOLD, 14.it
inthefollowinglocation; 1E Basement [2 /stFf. ❑ 2nd Fl. CUT/BARN Section Block Lot
was examined on AUGUST O G , 19 9 3 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FA
RECEPTACLES SWITCHES NS
OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. I AMP. TYPE METER EQUIP. 4W 1..3W 3 03W 3,9 4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W G.
EQUIP. PER 21 OF CC.COND. OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
DEF,E CTS REMOVED F8 PER 03/02/93-1
FEEDERS 11-3 U' 10 13ASFiVENT TO BASEMENT
PANLLDOARD5 a 1-4 CTR. 3
G & S CONTRACTOR LTC . M78 -E
BOX 21 S
S O[(y'f$t1[,D + Pi , 11971
. GENERAL MANAGER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR EM MMIS DEPART M EMY. TI G91S COPY OF MUC a(,'O T BE P1 u E LLD W AFHY MANNER.
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UNATHORIZED ALTERATION OR ADDITION � r
TO THIS SURVEY IS A VIOLATION OF
SECTION 72D9 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING L ��
THE LAND SURVEYOR'S INKED SEAL OR '
EMBOSSED SEAL SHALL NOT BE CONSIDERED K 'r r� N
TO BE A VALID TRUE COPY.
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GUARANTEES INDICATED HEREON SHALL RUN O
ONLY TO THE PERSON FOR WHOM THE SURVEY �O, �r3
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND �N!n O
LENDING INSTITUTION LISTED HEREON, AND
ASSIGNEES OF THE LENDING INS 1-
TO THE
To THE GUARHNTEES ARE NOT TRANSFERABLE. ►C�` ���o 0
THE EXISTANCE OF RIGHT OF WAYS o °• N
AND/OR EASEMENTS OF RECORD, IF
ANY. NOT SHOWN ARE NOT GUARANTEED. o 0
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Joseph A. - Ingegno
PREPARED IN ACCORDANCE WITH S MINIMUM
STANDARDS FOR ACCORDANCE
SURVEYS T E MINIMUM
BY THE L.I.A.L.S. AND APPROVED AND ADOPTED N
FOR LE ASSOCIATION. THE NEW YORK STATE LAND
TITLE L4
Land Su "eyor
N W Y0 O \Y1
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Title Surveys — Subdivisions — Site Plans — Construction Layout / Gj5 AH 'Fyo9� y"5l
PHONE (516)727-2090
Fax (516)722-5093 1
MAILING ADDRESS 1,
OFFICES LOCATED AT P.O. Box 1931 N.Y.S. l ic. No. 49668
One Union Square Riverhead, New York 11901
Aquebogue, New York 11931
93—
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SURVEY OF PROPERTY
SI T UA TED AT
SOUTHOLD
RUST TOWN OF SOUTHOLD
o/F LIVING SUFFOLK COUNTY, NEW YORK
/0, Jr' 25'��a S.C. TAX No. 1000-55_06-33.2
- ED�rIN Mo 000 3�55 06—P/0 33. 1
SCALE
TgE MAY 17, 1993
0 0. CERTIFIED TO:
RACHEL VOEGELIN
CHICAGO TITLE INSURANCE COMPANY
N \\ PARCEL I AREA = 87,120.00 sq. ft.
Po�� 2.0000 ac.
w000 2,•s• V0 of \\ ��G�\�'5����6� PARCEL II AREA = 14,895.00 sq. ft.
DO 0.3419ac.
P o
\\m P* N°' , TOTAL AREA = 102,015.00 sq. ft.
2.3419. ac.
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SCALE 1" =30'
MAY 17, 1993
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LONG
BUILDING DEPARTMENT
TOWN OF SOUTHOtiD
HOUSING CODE INSPECTION REPORT
LOCATION:
number S street municipality
SUBDIVISION 'MAP NO. LOT (s)
NAME OF OWNER (s)
OCCUPANCY
(type) (owner-tenant)
ADMITTED BY: . r -JCr9�u�� ACCOMPANIED BY: G
KEY AVAILABLE SUFF. CO. TAX MAP NO.
SOURCE OF REQL-BISi: DATE:
DWELLING: 11
TYPE OF CONSTRUCTION STORIES # EXITS
FOUNDATION CELLAR CRAWL SPACE
TOTAL ROOMS: 1ST I.R. 2ND FLR. 3RD FLR.
BATHROOM (s) TOILET ROOM (s) `T— UTILITY ROOM �-
PORCH TYPE DECK, TYPE PATIO, TYPE .
BREEZEWAY FIREPLACE GARAGE
DOMESTIC HOTWATER PC TYPE HEATER J AIRCONDITIONING
TYPE HEAT�� WARM AIR HOTWATER
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. STORAGE, TYPE CONST,
SWIMMING POOL GUEST,- TYPE CONST.
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
OCATION DESCRIPTION ART. SEC.
tr
a
r •
REMARKS:
v
INx/W
S .ECTED BY: DATE ON INSPECTION
TIME START END r
THE NEWYORKBOAROOF FIRE UNDERWRITERS I Form No.
WE ARE IN THE PROCESS OF ISSUING A ;
CERTIFICATE OF COMPUANCE FOR THE TOWN OF SOUTHOLD. �'�n R,�L k, G e _rzp d' �S�
EL N AN APPLICATIOALNOTEON AS D BELOW EKED
BUILDING DEPARTMENT 026 SA x o n A U e-
APPLJ ON NO.
e� TOWN HALL 6l� .f Clo F-e � Y.,, Al� 765-1802
uocanoi&Si�:A�a mow
ION FOR. CERTIFICATE OF OCCUPANCY TO
INSPECR oaTE pC tic
A.
ISO(REV 9190)
T M���=_ �.�•uer .�c GC.cTs j
11,,.1ed in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. Of water supply and sewerage-disposal(S-9 form) . .
3. Approval of electrical .installation from Board of Fire Underwriters.
4. Sworn Statement from plumbe certifying that the solder used in system contains
less than 2110 of 1% lead. -
5. Commercial building, industri l building, multiple residences and similar buildings
and installations, a .certificate of .Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approv Of 'comp' leted site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
if land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. ' A properly completed application. and a .consent to •inspect signed by the applicant.
If a Certificate of Occupancy 'is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
20�-� Additions to accessory building $25.00. . Businesses $50.00.
Certificate of Occupancy on Pre-existing Building - $100.00
. 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date
New Construction. . . . . . .��.//. . . Old Or Pre-existing Building. . . .X . . . . . . . . . . . • . . . . . . . • .
Location of Property.-� .f73,Xs1iAl , Road, _ . . Southold
House No. Street Hamlet . . . • . . . . • . .
Onwer or Owners of Property. . . . . .1VMWIA A. .MOONEY , , , , , . .
County Tax Map No 1000, Section. Q.5,5:QQ. . . . , .Block. . 06:Q0. . . . . . . .Lot. .
Subdivision. . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . ... . . . . . . . . . .
?ermit No. . . . . I. . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . ... . . . . . . . . . . . . . . . .
Iealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval.. . . . . . . . . . . . . . . . . . . . . . . .
Tanning Board Approval. . . . . . . . . .. . . . . . . . . . . .
tequest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
'ee Submitted: $. . ✓eff. . . . . . . . . . . . . . . . . . . . .
,12
APPLICANTY`-
- C _
FORM 3(RE V.1/90) THE .NEW YORK BOARD�YDF FIRE UNDERWRITERS
ELECTRICAL DEPARTMENT
i
RESPOND TO:
A.J. REED, GENERAL MANAGER t y J
r/85 John Street ❑ 41 State Street ❑ 570 Delaware Avenue ❑ 217 Lake Avenue ❑ 202 Arterial Road
NEW YORK,NY 10038 I ALBANY,NY 12207 I BUFFALO,NY 14202 I ROCHESTER,NY 146081 SYRACUSE,NY 13206
(212) 227-3700 (518)463-2122 (716)884-1155 (716)254-0141 (315)463-8552
THIS IS A REPORT OF (SEE BOX CHECKED HEREUNDER)
i
A. ❑ NON-INSPECTION B. ❑ INSPECTION C. ®''ELECTRICAL SURVEY
JOB LOCATION:' �l Y,L ,2. (9.Ct� " K rJ !IDA I b P�in4ig.,f -S d� �
APPLICATION N l—9-3 PERMIT NO.:
, �h�'t-tZs�' �-g �A�9�t1. 'I OWNER/
TO:
TENANT -r _
ADDRESS
"
ANON-INSPECTION: We have received your application for an inspection of the electrical installation made by you at the
premises•named herein but we have been unable.to make'the inspection for the following reason:
❑.Floor location and name of tenant not furnished ❑ Premises locked, no entry possible.
❑.Floor,location of building.not furnished ❑.Other.•
Inspector's Signature Date
Please provide; the necessary, information or suggest arrangements for our access to the premises on-the green form
attached and�return it to this office.
Applicant's Signature Date
B. C.
INSREGTIO.N OR ELECTRfGALSURVEY:..We,have attended,at the premises n,am`ed herein to inspect the electrical
installation and.eegret that we can'not'issUe a certificate of compliance for the reason(s),listed hereunder;
❑: ncealed work.Co not exposed sufficiently ; ❑.Additional el.ectric`al .work�found for.which'no application
"for-inspection. .:for inspection has,'been:-,received.
❑, Installation not completed sufficiently O'Electrical'installation does not corrip_ly With National
for inspection. Electrical Code for reasons listed hereunder:.
;(see reverse,side`for,kplanation of'coding)
KEY TO FORM: Code number printed under BLACK column'listed below-cdnibined with code'number printed under,RED column listed below
indicates condition. EXAMPLE:BLACK RED ='Service Conductor not of"proper capacity.',
.76 45
BLACK' "''RED FLOOR'' . BLACK RED FLOOR- %.BLACK :RED-., FLOOR BLACK rRED. FLOOR
Gumizz-
,� _ J. ��� �;� - ,- , fir;, ��, -.; , I --. .- . : ., .. . :•
.ol T -TS64 at G' Ro L-L*-LO + SW G
53.
t'` '
Inspector's.Signature,, , Je Date
NOTICE TO APPLICANT: ;Please sign; date and return-green-copy of,this-
form to request re-inspection when modifications have been made. _ APPLICANT'S SIGNATURE DATE
NOTE: IF THIS IS A REPORT OF ELECTRICAL SURVEY, A NEW APPLICATION MUST BE MADE FOR RE-INS` ,
BUILDING DEPT.
. KEY TO'•F,ORM_:.Code'number,-printed-under.BLACK-column;-combined with code number printed
under RED;,column.indicates.condition: -- - _-
EXAMPLE: BLACK RED = SERVICE CONDUCTOR NOT OF PROPER CAPACITY
76- 45 - - '- - -
= BLACK COLUMN
1. AIR CONDITIONER 23. FITTINGS 46. MOTOR BRANCH CIRCUIT 68. RECEPTACLE PLATES 90. SPLICE BOXES +1
2. APPLIANCE :24:FIXTURE CANOPIES .47. MOTOR CONTROLS 69.-RECEPTACLES 91. SURFACE-METAL RACEWAY
3. APPLIANCE CIRCUITS 25' FIXTURE OUTLET BOXES 48.•MOTOR DISCONNECT MEANS 70. RECEPTACLE OUTLET BOX 92. SURFACE METAL RACEWAY
4. APPLIANCE RECEPTACLES -26. FIXTURES- -- - - 49. TEMPORARILY DELETED _.'_ _71, RECESSED.FIXTURES _ CONDUCTORS
5:'BONDING BUSHING- 27. FIXTURESOCKE7S = 50.-MOTOR'EQUIPMENT- 72.'RHEOSTAT 93. SWIMMING'POOLMOTOR/S
6. BRANCH CIRCUITS 28:FIXTURE CONDUCTORS - - 51. MOTORS--' - 73. SEALING FITTINGS 94.-SWIMMING POOL-JUNCTION BOXES
7.,BRASS SHELLSOCKETS• 29. FLEXIBLE CORDS, 52. MOTOR TERMINAL BOX 74• MORE THAN ONE SERVICE 95. SWIMMING POOL GROUNDING
8. BUSWAYS, 30.-FLUORESCENT FIXTURES `•53. MOTOR WIRING 75:SERVICE 96. SWIMMING POOL LIGHTING
9.'CABINETS" 31.'FURNACE CONTROLS " 54: MULTI OUTLET'ASSEMBLY "76. SERVICE CONDUCTORS"'• 97.=SWIMMING POOL RECEPTACLES
10. CABLEBUS'- -32: GENERATORS --- - 55:NEUTRAL CONDUCTOR 77: SERVICE CONDUIT - ---- 98. SWIMMING POOL----- - -
11. CABLE BUSHING 33. GROUND FAULT INTERRUPTER 56. NON-METALLIC CABLE Z8:SERVICE DISCONNECT,MEANS TRANSFORMER
12. CABLES 34. GROUNDING ELECTRODE CLAMP FITTINGS I �� 79. SERVICE DROP" - '99. SWIMMING POOL WIRING
13. CONDUCTOR ASSEMBLIES 35. GROUNDING ELECTRODE CONDUCTOR 57. NON-METALLIC CABLES 80.�SERVICE ENTRANCE CABLE"- 100. SWITCHBOARDS
14. CONDUCTORS 36.,GROUNDING ELECTRODES 58. OPEN WIRING CONDUCTORS,81.SERVICE EQUIPMENT, �,101: SWITCHES
15. CONDUIT 37. HEATERS 59. OUTLET BOX COVERS''! "!82. StRVIC9'HEAD'` "`102.'SWITCH-OUTLET BOXES
'
16. CONDUIT FITTINGS 38. INSULATED BUSHING 60. OUTLET BOX FITTINGS 83. SHOWCASES 103. SWITCH PLATES
17. CONTROLS '` 39. JUNCTION BOX COVERS 61. OUTLET BOXES-" : - F 84:,SIGN•CON000TORS "- '- 104. SWITCH WIRING
18. CUTOUT BOXES 40. LAMRGUARDS ;,t 62. OVERCURRENTDEVIC,ES; 85.-,SIGN DISCONNECTMEANS, 105.,TEMPO RARY WI RING
19. ELECTRIC METALLIC TUBING 41. LOIN VOLTAGE EQUIPMENT 63. PANELBOARO COVER' 86. SIGN'FRAME" "106. TRANSFORMERS"
20. EMERGENCY SYSTEM, 42. MACHINE TOOLS 64. PANELBOARDS 87. SIGN HIGH VOLTAGE 107. U.F.CABLE
21. EQUIPMENT GROUNDING •43: METALCLADCABLE ':Imo: "'65."RACEWAY CONDUCTORS " EQUIPMENT'^ •'`108'UN'DERFLOORRAGEWAY-
CONDUCTOR• -44.-.METAL CLAD CABLE FITTINGS. '_;•,66: RACEWAY FITTINGS 88:;SIGNS- , I!; 109..WIREWAYS;.- j
22. FEEDERS 45. METER EQUIPMENT 67. RACEWAYS y 89. SMOKE`DETECTDRS`"•' 110."WIRINGMETHODS - '
RED COLUMN
1. DEFECTIVE 23_NOTEXPLOSIONPROOF 44. NOTOFATYPELISTED__ _ _ 66. NOT PROPERLY JOINED 86. NOTPROVIDEDWIT_H_
2. DETERIORATED 24. NOT EXTERNALLY OPERABLE FOR UNDERGROUND 97. NOT PROPERLY LOCATED PROPERF SEALING
3. DOES NOT DISCONNECT 25. NOT FASTENED AT PROPER 45. NOT OF PROPER CAPACITY 68. NOT PROPERLY LOCATED COMPOUND
- .;,-ALL CONDUCTORS;, INTERVALS 46. NOT OF PROPER GAUGE IN CLOTHES CLOSET 87. NOT PROVIDED WITH THE
4. DOES NOT DISCONNECT ALL 26.- IN'NOT FLUSH -.47. NOT OF PROPER POLARITY 69. NOT PROPERLY MOUNTED PROPER OVERCURRENT
UNGROUNDED "' 27:NOT ACCORDANCE'WITH 48. NOT OFPROPER-RADIUS . -'r70. NOT PROPERLY SEALED.. : . PROTECTION _
CONDUCTORS ARTICLE N680 AT BENDS 71. NOT PROPERLY SECURED 88. NOT RAIN TIGHT
5. DOES NOT HAVE AMPLE SPACE 28. NOT IN ACCORDANCE WITH +-.f;;:49„NOTOF,P, OP.ERTYPE, - ----TO-FITTINGS - -' -----'-- 89..NOT-READILYACCESSIBLE
6. DOES NOT HAVE NAME PLATE CODE STANDARDS 50. NGT OF TYPES 72. NOT PROPERLY SEPARATED 90.'NOTTO BE CONNECTED
7. DOES NOT HAVE -,. 29. NOT-IN OPERABLE 51. NOT OF THE GROUNDED-TYPE _ 73.-NOT PROPERLY-SUPPORTED- ._ . ABOVE SERVICE HEAD _
PROPERCLEARANCE `CONDITION ' " ' 52. NOT PROPERLY-ASSEMBLED 74. NOT PROPERLY SUPPORTED 91. NOT TO BE CONNECTED TO
8. DOES NOT HAVE PROPER 30. NOT IN COMMON RACEWAY 53. NOT PROPERLY BONDED IN VERTICAL RACEWAY THE GROUNDED
SPACING',— • " ' '• +31. NDT IN SIGHTOF`OR- ' 54: NOT PROPERLY BUSHED" '75. NDT PROPER LY'•TERMINATEOi CONDUCTOR
9. DOES NOT MEET REQUIRE- LOCKING TYPE 55. NOT PROPERLY ENCLOSED 76. NOT PROPERLY TREATED AT 92. NOT TO BE INSTALLED ON
MENTSOF ARTICLE M500. . ,_:::32:NOT INSTALLED' •.56.,-NOTPROPERLN;FASTENED ',_ BOXES • r ,. ' _ ;?.r,SMALL APPLIANCE CIRCUIT
10. DOES NOT TERMINATE IN „ 33. NOT ISOLATED 57. NOT PROPERLY FUSEQ 77 NOT PROPERLY WIRED WHEN FUR GENERAL USAGE
LISTED FITTINGS 34.`NOTLIQUIDTIGHT'^' '" '• 58:'NOTPROPERLYGROUNDED•' :• '78:NOT-PROTECTED FROM 1 "! :93.:NOTTO BE.MORETHAN;SIX
11. EXPOSED TO MOISTURE 35. NOT LISTED EQUIPMENT 59. NOT PROPERLY IDENTIFIED CORROSION MEANS OF DISCONNECT
12. HAS EXCESSIVE NUMBER 36. NOT LISTED FOR DIRECT 60. NOT PROPERLY INSTALLED 79. NOT PROTECTED FROM 9.4. NOT TO BE USED AS A
OF BENDS BURIAL -61..NOT PROPERLY INSTALLED PHYSICAL DAMAGE JUNCTION BOX
13. HAVE OPEN KNOCK-OUTS 37. NOT'LISTED FOR,HAZARDOUS _ .RELATIVE TO COMBUSTIBLE 80. NOT PROVIDED 95. NOT TO BE USED AS
14. TEMPORARILY DELETED AREA USAGE MATERIALS 81. NOT PROVIDED WHERE RACEWAY
15. IN EXCESS - - 38. NDT'LISTED,FOR USAGES -62. NOT PROPERLY INSTALLED CONDUCTOR SIZE IS 96. NOT UNBROKEN
16. IN INSUFFICIENT QUANTITY' AS APPLIED' RELATIVE TO HEIGHT ;' J-REDUCED 97. NOTWATERTIGHT
17. INSUFFICIENT 39. NOT LISTED-FOR SERVICE- -63. NOT PROPERLY-INSTALLED `•;82. NOTPROVIDED,WITH:A 98:-NOT WEATHER PROOF-
18. LARGER THAN N 8 SHALL BE' EQUIPMENT USAGE RELATIVE TO WATER MAIN DISCONNECT MEANS 99. OF EXCESSIVE LENGTH
STRANDED WHEN IN A ---- 40.-NOT LISTED MATERIALS- - - OR GROUNDING 83. NOT PROVIDED WITH A - 100. OVERLOAD.- - -- ----
R'ACEWAY-" ' 41. NOT OF A NON-INTER-;., ELECTRODES GUTTER 101_ REVERSED
A. MISSING _ CHANGEABLE TYPE 64. NOT PROPERLY INSTALLED-- -- 84. NOT PROVIDED WITH _ _ 102. SUBJECT TO EXCESSIVE HEAT
20. NOT AT POINT-OF ENTRANCE 42.TEMPORARILY DELETED RELATIVE TO WATER AND PROPER DRAINAGE 103; TEMPORARILY DELETED
21. NOT CAPPED ;` 43. NOT OF A TYPE LISTED STEAM PIPES 85. NOT PROVIDED WITH THE, 104,USED IN PLACE OF AN
'22.-NOT CONTINUOUS - -' -FOR OUTDOORS -65.- NOT PROPERLY INSULATED- ""' PROPER FITTINGS - ACCEPTED WIRING METHOD
FORM 3(REV.4/83).
i f
CONSENT
To .
INSPECTION
PATRICIA A. MOONEY, the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
Soo ITS m*.)Av
of Southold located at Road, Southold, NY
which is shown and designated on the Suffolk
033, 2
County tax map as District 1000, Section 055.OJ1 Block 06.00 , Loll,
That the undersigned (has) (-ka-ve}filed, 'or caused to be filed, an applica-
tion in the Southold Town Building Inspectors Office for the following:
Certificate of Occupancy for Pre-existing building
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter 'upon the above described property, including
any and all buildings located thereon, to conduct such inspections as they may
deem necessary with respect to the aforesaid application, including inspections
to determine that said premises comply with all of the laws, ordinances, rules
and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the
knowledge and understanding that any information obtained in the conduct of
such inspections may be used as evidence in subsequent prosecutions for vio-
lations of the laws, 'ordinances, rules or regulations of the Town of Southold.
Dated: April 30, 1993
(signature)
(print name)
(signature)
(print name)