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Home My WebLink AboutZ-9992FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... ~.999.2 ........ Date ...... .rT...gl3.e. 3.9 .................. 19..8.0 THIS CERTIFIES that the building ................................................ "Laurel Way" Mattituck Location of Property .............................................................. House No. Street Hamlet County Tax Map No. 1000 Section . .17.! ....... Block .... ~.. .......... Lot ..... !.6 .......... Subdivision ............................... Filed Map No ......... Lot No .............. ~eQuirem~nt~ ~gr ~ one-family dwelling MiLt. urior to conforms substantially to the ~t~l~i,cmt, iom.~or-~u, im.}v~..~e, rm,t-h,r~UoT-rTe~_fi~0~l;m April 23 ,1957 Certificate of Occupancy ........................ pursuant to w~i~h-Buitdi~g-lae}-mit No,. -.-.-..¥~E ........... dated ..... 0'.u~..e...1~ ............... 19..8.0, 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 ......... ..... ?.r~,v..a.~.e..9 .n,e:-.~ .~. ~.1.7., .Dw.e.~.% .~.ng .......................................... The certificate is issued to ...... ~.r.i.l.l.~.9 .m' .ff..... ~.:l..1.t?o..~.~. ?.r.: ~..ff. e..a.n..C. :..W.:L.]:B. ?.~.~. ;...Jg.8. eph J. (owner, lessee or tenant) of the aforesaid building. Sergio & Constance Sergio Suffolk County Department of Health Approval ...... N./.~ ................................. UNDERWRITERS CERTIFICATE NO ............. .N./.R ................................. Rev 4/79 Building Inspector BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTION REPORT (number & street) (~l~f _ (Municipality) / Subdivision, -- Map No. , ,,,-- Lot(s) .... Occupancy (owner-ten.t) A~itted by: ~L~ .... Accomp~ied by:~ Key availabl~//~/~.~/~ Suffolk Co. / Source__7 Date DWELLING: ~e of construction Foundation Total rooms, 1st. Fl~- Bathroom(s) Porch, type Breezeway Type Fireplace(s) ~-~ Domestic hotwater 0ther~ ~r .~/,~A~y~ ~,,'~X/L{~ #stories, Cellar - Crawl space...~ ~sznm. F1 ? 3rd. F1 -- Toilet room(s) Deck, type ~ '- Patio, Garage Utility room typq__ Warm Air c3~m ~/~ Hotwater No. Exits~~-) Airconditionin~ Type heater ACCESSORY STRUCTURES: Garage, type const.~/~?l~/~ Storage, type const. Swimming pool Guest, type const. VIOLATIO,NS: Housing Code, Chapter 52 ._Location . . Desc.Tiptign Art. Sec. ' ~ Il z/~ Inspected by: Time s t ar t//z ~6-~.~.end F01~I 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 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 D~S~,~1' ~ unusual natural or topographic features. ~. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). ~ ~. 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 S..CT~0~J the building. · Submit Planning Board approval of completed site plan requirements where applicable. B. ~r existing buildings (prior to April 1957), Non-conforming uses, or buiJdings and "pre-existing" md uses: Accurate survey of property showing all property lines, streets, buildings and unusual natural I~LOCI~ or topographic features. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. _C. F/~es: L?,'~- 11 Certificate of occupancy $5.00 ~2~ Certificate of occupancy on pre-existing dwelling or land use $5.00 3,~ , Copy of certificate of occupancy $1.00 . .~...~..,~....~...~. I~ [ Date New Building ................ Addition ................ Old or Pre-existing Building .....~.. .....Vacant Land .............. L ~\\ ,Q ~ ocation Of Property ....... ...~..~.¥~...'~. ....... ....~. '. ...... /.,...kt~.~.,.~,..t2...,z"~,,..~ ........ ,. ............................... Owner Or Owners Of Pr°perty~"k~!~"~'''~'k'i'''?~''''L''~-'~'''~:-'''~''''''t~''']~'~'''!~9''5~'''~' '''~'~'''~'~ID' Subdivision ................................................................ Lot NO ............. BlOCk NO Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ ~l~inal Certificate .....~. ............................... Fee Submitted$ ....~....~ .............. / , / x~ Construction on above described building and pe~ff/j~m~et//a, ~/aapplicabl,/c~des and regulations. . Apphcant ...~..~ ............................ ~ ............................... Sworn to before me ~h~ ~.~... d.y ~.,..Z~.Z~ GARY FLANNER OLSEN ESQ. ........... P. 0. ~'~ o, ,~) . I.~t~ Nota~ Public .................................... Coun, Main Road ~ ~,~ ~ttituck, L. I., N.Y. 11952 ~ I