HomeMy WebLinkAboutZ-6197FORK NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 46.'1.97...... Date ............LTOV ..7........, 19.7��
THIS CERTIFIES that the building located at /.S . e.ix" c..St.......... Street
Map No. x......... Block No.. =.......Lot No..x�.�
conforms substantially to there uirements for one family dwel, n & Housing code
rterr'►7=1 Fit rY: r,C?FiiJT�
bu eP f oceunaZ,64 g7. xac
date bf�ore April 2 19 5'% pursuant to which B o. y
.
dated ......... RON .....7 .... , 19-741., 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 .P.rivate . one . f=j ly..dijre..ljng .......... .
The certificate is issued to ..Andrlanua VariRy. m-rYg% . & . W f.e . , , . ,Y? T%r4
of the aforesaid building. (owner, lessee or tenant)
Suffolk County Department of Health Approval pre— exis. ink
UNDERWRITERS CERTIFICATE No. .P''' —.
HOUSE NUMBER ...240........ Street ... Ra c i f l c . St ..........................
................................................................................
..........
Building Inspecto
HOUSING CODE INSPECTION
November 7, 1974
240 Pacific Street R-1
Mattituck, N. Y.
Tax Roll: Andrianus Van Ryswyk & Wife
Unoccupied
Upon request for a Pre-existing Certificate of Occupancy for
this one family dwelling, I made an inspection and found no
violations of the Housing Code, Chapter 52, Town of Southold,
N. Y. I was admitted to premises by Mr. Van Ryswyk who accom-
panied me during inspection which began at approximately 10:50
A.M.
The building is a two story framed structure and consists
of the following rooms:
First Floor:
Kitchen, pantry, dining room, living room,
full bathroom with connecting dining room and
sun porch.
Second floor: Two bedrooms and full bathroom.
Hot water heat is furnished to all rooms on first and
second floors, with the exclusion of sun porch, from oil fired
furnace located in partial cellar, with crawl space for balance
of foundation.
Exterior of building and grounds is in good order.
Resppctfully ubmitted,
EH:mm E ward Hindermann
Building Inspector
VORM NO. e
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 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
Date .......... ul�r7
.....1., 78
...19
New Building .................... Old or Pre-existing Building .... X.-C.QRY......... Vacant Land ............................
Location Of Property E/S Pacific Street, Mattituck, N.Y.
.................... ......................
OwnerOr Owners Of Property .....................................................
Subdivision................................................................Lot No............. Block No............. House No.............
Permit No ..................... Date Of Permit ....................Applicant , Gary Olsen. Esquire
.........................
HealthDept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planninrd Approval
Request For Temporary Certificate ..................................:..... Fin Certificate ..........................................
Fee Submitted $....i.t.QQ......................
Construction on above described building and
Applicant ...........
Sworn to before m/th*
,per..... day of .... ..../.. //.�....
Notary Public ................. ................. County
applicable codgd and regulations.
(stamp or seal)
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