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HomeMy WebLinkAbout1000-22.-2-32 TOWN OF SOUTHOLD Racal Pant �y§ 0368 Owner Cornelia Mitchell Occupied as Single Family Dwelling Located at 1620 Aquaview Ave East Marion 22.-2-32 Maximum Permitted Occupancy 5 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 9/16/2024 AOL". der)e e� official This Notice must be posted by the main entrance at all times TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Halt Annex 54375 Main Road P. O. Box 1179 Southold,NY It 971-0959 Telephone (631)765-1802 Fax (631) 765-9502 iLt�L)�s.:J/www.sotjtl'iol(iLoAlmy:ga D ECEHE ­ RENTAL PERMIT APPLICATION fl AUG - 7 20P4 Rental Permit Fee $300 (Application must be renewed every two years) Bu"fflng Dr�parlrnent Town of '130ug.'hokj Section A. Property Information: 0) Rental Property Address:/ // 6 , A U )( 6(j) 4 (1 Tax Map Number: 1000 SECTION 2- -BLOCK -LOT SECTION B. OWNER INFORMATION: Property Owner Name: /to IE Property Owner Legal Address: Property Owner Mailing Address: (Cannot be the same as Rental Property Address) e- 'FLAVA -DAI, REV, 902,"A 4/0- may- Telephone Number(s): Dayffirine Evening_ Emergency 6M f d Property Owner Email Address: AW 1 Page I of 4 L4 ��'`� Section C. Authorized Agent Information: U 71�p`L / �,P ,A6-r J4 � fd M � Name of Authorized Agent of dwelling unit, if any: /� Address of Authorized Agent(no P.O. Boxes): � As M 66 o,`� Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Section D. �� Managing Agent Information: �' ,y M A646(IV e 4 6� Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. 6 SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: Address of Managing Agent (no P.O. Boxes): Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: Page 2 of 4 SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: 0 N,15 For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier (for example, Unit 1, Unit 2, Unit 3 or Apt A, B, C);the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use"Rental Permit Application Addendum." cc U � LL Rental Dwelling Unit Identifier: S�M7 Requested Maximum number of persons allowed to occupy Dwelling Unit:�. 74 Number of rooms in Rental Dwelling Unit: 2- A / "� ����/AIL ��I U e an '�rr en�sion�o� ro m Re t'&Peeftnig Unit:" X SECTI t; INSPEC N: Pursua t to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspec ion by Code Enforcement Official is required. If the owner chooses not to have said inspec ion performed by the Town, a certification from a licensed architect, a licensed profes ional engineer or a home inspector who has a valid New York State Uniform Fire Prevei tion Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town f Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the 'aws adopted by the New York State Fire Prevention and Building Code Council. am requesting a fire safety inspection to be performed by a Code Enforcement Official om the Town of Southold I m submitting a completed Town of Southold certification form from a licensed ar itect or a licensed professional engineer. Page 3 of 4 02 `P 1 A6�4(04-( ��ob t Qo6 SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) ierrtify under penalty of perjury, the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to all applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days s to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name: ( / � /V Tt ! � L �. " Property Owner's Signature: Sworn to before me this L1-day of 202A "MI cer"(Ste Official Notary Public Signature and Original Notary Stamp I 1"1' V Page 4 of 4 *„ rg.✓-.Epp, "',P yo uW. Town Hall Annex ���m, Telephone(631)765-1802 54375 Main Road P.O. Box 1179 t �r Southold, NY 11971-0959 �4 BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION ADDENDUM Rental Dwelling Unit Identifier: Requested maximum number of persons ,alto to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: Rental Dwelling Unit Identifier: Requested maximum number of persons allowed to occupy each dwelling unit: Number of Rooms in Rental Dwelling Unit: Use and Dimension of each room: 14 � �c Itgad *I . r� 1 J V lL �2 ND N u _ .._ 0 31 D 0 C@ u��,m ��,� , ✓f�,r� y + i I, Y =� O ,• F oua m q D _y wq 1 pg r q r. L.0 l , T 80 m,_ 1 T w=P pa . c0 b�' �3Cm_io ...et �d {�}J ay a II Z 4-51 I� �oCD \ m D G7 D _.....�.ww__... _.. .... ............ .. . I m z� 7 z $ b X,D�m " � � ��•. h c� m D N V� zm0� } Z 4 O W �� s -d Zq �zect -I fll rnq �:p Neu' » Df (n �� �� a� w t �m Z D _ " Q •5 z � 3 � m z u m yp Zl 7y Z =� oz o '`ZZ m o f—` v ! Z 1 1 m I 2 ry 71 l'< m 22 zi oz Fl Sl do n zs torn l I m salr�� 1 �w TOW OF OUTHOLD BUILDING DEPT. � 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ NAL [ ] FIREPLACE & CHIMNEY [ FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEN TRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (F AL) [ ] CODE VIOLATION [ ] PRE C/O [ RENTAL REM 7 RKS: �rwwn oom kf)R j A � kq( . GA- tJ � � alaoi� OWNER STREET 7� VILLAGE DISTRICT SUB, LOT s - � i frORNAER OWNER _ E ACREAGE -- ----- S ,C) I W 1pv = TYPE OF BUILDING Ytj RES. SEAS. VL= FARM COMM. IND. CB. MISC. � LAND IMP. TOTAL DATE REMARKS F -- ✓ - _ �a l n rt } At A - 3 AGE BUILDING CONDITION V NEW NORMAL BELOW ABOVE Form Acre Value Per Acre Value v� Tillable 1 Tillable 2 - ` Tillable 3 Ak, Woodland r Swampland Brushland i House PIT Tor^ I y 22. 2-32 01/30/2017 T— T S M. Bldg �.� Both - � 3 So_a - ar�clot�o Extension Bosern rat Floors t'� n z Extension 1 fit} _ Interior Finish Jh t et L E ctension Fire Place V4 Heat Porch Attic F Porch Rooms ]st Floor I , Breezeways Patio Rooms 2nd Floor�m Garage Driveway O. B, _ s FORM NO. 4 26A TOWN OF SOUTHOLD ak BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. @ ck- CERTIFICATE OF OCCUPANCY No. Zlti-28.. . ........ Date ... . . .. ........ September .27...... 1962. THIS CERTIFIES that the building located atW/S. Stars -Road & SIS Aqua AkW AVe Map No. ..,9tarS_ Block No. ....00),.A. !lot NO- ­Xxx. . .....Bast- Marlenr conforms Eubstantially to the Application for Building Permit heretofore filed in this office dated ......April Ia.. 19,62. pursuant to which Building Permit No. Z1.710 dated . Mo.,J. . 1962 , 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 ....$>rIvato one family dW48-111ng This cert;f leate is issued to .Barry 1,41tche-11 - ..Owner .... ..... (owner, lessee or tenant) of the aforesaid building. H,D.Approval Sppt 18th, 1962 by R. Villa Building Inspecto Town of Southold 12/1/2016 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38685 Date: 12/1/2016 THIS CERTIFIES that the building ELECTRICAL Location of Property: 1620 Aquaview Ave., East Marion SCTM#: 473889 See/Block/Lot: 22.-2-32 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated l l/l/2016 pursuant to which Building Permit No. 41133 dated 11/1/2016 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: L-00 M'1 1 w 1 Q SIl��:1C'1�.�tGRAD137 AN )w;�ll " RE "131' ACLES IN K.IT`CIJ The certificate is issued to Mitchell,Katy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41133 11-23-2016 PLUMBERS CERTIFICATION DATED ................. _ _ ..... .. .. .. . uthorized Signature ._.._... _ . ..................._ _ .... ... _._.._. M..w _ . w...w_ _w ... _ww w_ww„_. _ �.............._.... __. µ F04 Town of Southold 12/3/2020 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41651 Date: 12/3/2020 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 1620 Aquaview Ave,East Marion SCTM#: 473889 Sec/Block/Lot: 22.-2-32 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/11/2020 pursuant to which Building Permit No. 45230 dated 9/21/2020 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: "as built"alterati includin baftoom in basem—t t,,an e:cistin -1-mlq ly dr elling.� el for.. The certificate is issued to Mitchell,Katy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF I°IEALTII APPROVAL ELECTRICAL CERTIFICATE NO. 45230 11/6/2020 PLUMBERS CERTIFICATION DATED 7/30/2019 K mbl !g lbating Signature _...._.�,..�.....� 8 ' EC E UWE CORNELIA MITCHELL AUG -, 7 2024 8130 CALABAR AVENUE PLAYA DEL REY,CA.90293 Building Department Cory.M.M-ftbel(-@bgma1Lcojm Town of Southold 310-702-6548 Ms.Connie Bunch Town of Southold Building Department Southold, NY. Re:Rental Inspection Application For 1620 Aquaview Avenue East Marion 11939 Lot 22-2-32 Dear Connie: Greetings. Hope this finds you well in all ways and enduring the rather hot summer of the North Fork this year. I know it has been a tough summer. Attached please find my application for a rental inspection for the house above as well as the fee of $300. 1 have included a C of O dated 2020 but somehow I can't find a more recent C of O.The house was inspected in the fourth quarter of 2022.Would it be possible to check and see if there is a more recent C of O? would greatly appreciate if at all possible,to have the inspection done while I am at the house in September. will be there Thursday September 51h departing Sunday September 22nd I am traveling out of the country beginning this Saturday August 3`d and returning August 21't and best reachable via email at Cory.M. i�thallf�gal,cr�m. Wishingyou well in all ways and hope to see you while I am there. Thank you for everything.You have been nothing less than truly caring and helpful. All my best, 0 . Cory Mitchell TOWN OF SOUTHOL f� 4 ca } RentalPermit 0368 Owner Katy Mitchell Occupied as Single Family Dwelling Located at 1620 Aquaview Ave East Marion 22-2-32 Maximum Permitted Occupancy 5 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 2/5/2023 _ %ernfo nr0iial This Notice must be posted by the main entrance at all times �o TOWN OF SOUTHOLD co Rental Permit Permit No. 0368 Owner Katy Mitchell Occupied as Single Family Dwelling Located at 1620 Aquaview Ave East Marion 22-2-32 Village S/13/1- Maximum /B/LMaximum Permitted Occupancy 5 Is in compliance with all of the provisions of the code of the Town of Southold, the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. Expiration is two (2) years from date of issue. The operator is responsible for arranging for the bi-annual inspection. 12/2/2020 John Jarski Date of Issue Code Enforcement Officer This Notice must be posted by the main entrance at all times Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G nrN yQ Southold,NY 11971-0959 Qr�COU1Y 1,���•� BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PERMIT APPLICATION -{ D � � ,E,0V F-!-. Rental Permit Fee$200(Application must be renewed every tw)Xears) JUN 282019 DI) Section A. T0,17ITLN 03F SO ��La Property Information: Rental Property Address: laz2 4 a-vvCASA Tax Map Number: 1000 SECTION -BLOCK_ -LOT = SECTION B. OWNER INFORMATION: Property Owner Name:.,_ Property Owner Legal Address: Property Owner Mailing Address: No jHE r Telephone Number(s): Dame Evening Emergency Property Owner Email Address: A/0/V15 . 7 (' 6 MAII-I e,014 Page 1 of 5 (2AC q---I)qo soUryDl , Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �O Southold,NY 11971-0959 ell-c® �ztrr..r� BUILDING DEPARTMENT TOWN OF SOTJTHOLD -, RENTAL PERMIT APPLICATION INSTRUCTIONS Rental Permit Fee $200 (Application must be renewed every two years) The items listed below are required to be submitted with the completed application. ❑ Floor Plans: Floor plans of each Rental Dwelling Unit, please show location of all smoke &carbon monoxide detectors. ❑ Certificates of occupancy and Pre-Certificates of occupancy: Certificates of occupancy or Pre-Certificates of Occupancy for each rental dwelling unit. ❑ Certification of Code Compliance(form enclosed): Must be submitted by a license architect or engineer or license home inspector if an inspection by Town of Southold inspector is declined. ❑ Rental Permit Fee: $200.00 � d Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 d �4 coum BUILDING DEPARTMENT TOWN OF SOUTHOLD Section C. Authorized Agent Information: Name of Authorized Agent of dwelling unit, if any: Address of Authorized Agent (no P.O. Boxes): R1 4 MLA �,4 Z- Mailing Address of Authorized Agent: ;5l(0-16Z--609 Telephone Number(s): Daytime Eveninr Emergency Email Address: (� ly4 114 Section D. Managing Agent Information: Name of Authorized Agent of dwelling unit,if any: Address of Authorized Agent(no P.O. Boxes): Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION E. SITE MANAGER INFORMATION: (required for rental properties containing 8 or more rental units) Name of Managing Agent of dwelling unit, if any: -_ - Address of Managing Agent (no P.O. Boxes): jV� Page 2 of 5 ®� SDUryO r, �o o Town Hall Annex Telephone(631)76.5-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-09590 c®UN�1 BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: MIA Telephone Number(s): Daytime 1V 114.Evening 44Z,4 Emergency Email Address: /�('* SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: l For each Rental Dwelling Unit set forth the Rental Dwelling Unit identifier(for example, Unit 1, Unit 2, Unit 3 or Apt A, B, Q the use of each room in the Rental Dwelling Unit (for example, Kitchen, Bedroom 1, Bedroom 2, Living Room) and the dimensions of each room. For properties with multiple Rental Dwelling Units use "Rental Permit Application Addendum." Rental Dwelling Unit Identifier: Requested Maximum number of persons allowed to occupy Dwelling Uni . Number of rooms in Rental Dwelling Unit: �_ Use and Dimensions of each room in Rental Dwelling Unit: — 17-CN6A - &0k-4 Ag V/�/� /��F� ' /-/�/� . R l iii A ll O r Page 36f4^7, - ----- --- ------ ----- --- tnf SO Town Hall Annex ,}g, Telephone(631)765-1802 54375 Main Road Fax(63 l)765-9502 P.O.Box 1179 G c� Southold,NY 11971-0959 co BUILDING DEPARTMENT TOWN OF SOUTHOLD SECTION G. INSPECTION: Pursuant to the Town Code of the Town of Southold Chapter 207 (Rental Properties), a safety inspection by Code Enforcement Official is required. If the owner chooses not to have said inspection performed by the Town, a certification from a licensed architect, a licensed professional engineer or a home inspector who has a valid New York State Uniform Fire Prevention Building Code Certification is required stating that the property which is the subject of the rental permit application is in compliance with all of the provisions of the code of the Town of Southold,the laws and sanitary and housing regulations of the County of Suffolk and by the laws adopted by the New York State Fire Prevention and Building Code Council. ❑ 1 am requesting a fire safety inspection to be performed by a Code Enforcement Official /from the Town of Southold f�' I am submitting a-completed Town of Southold certification form from a licensed architect or a licensed professional engineer. SECTION H. DECLARATION: Signature must be notarized and MUST be the owner of the dwelling unit. l�In 1'1w-+iZV STATE OF NEWW ) Aevv+k.clm)e(` COU,N,,TTYY OF *) } I �4 1 y It,1 TC mortify under penalty of perjury,the following: 1. 1 am the owner of the property identified in "Section A" of this application. 2. The property owner's legal address set forth in "Section B" of this application is my legal address and I understand the Town will use the address for service pursuant to ail Page 4 of 5 �r i as, + sotr��® Town Hall Annex l Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-095900m,�"� BUILDING DEPARTMENT TOWN OF SOUTHOLD applicable laws and rules. I further acknowledge that I will notify the Town of Southold Building Department of any changes of address within five (5) days of any changes thereto. 3. 1 have read and received a copy of Chapter 207 of the Code of the Town of Southold and agreed to abide by the same. 4. 1 will notify the Town within five (5) business days as to any change to the information regarding Authorized Agent, Managing Agent, or Site Manager. Property Owner's Name:- 7� Property Owner's Signature: j Sworn to before me this ay of jO ne- , 201 C Official Notary ublic Si Oature and Original Notary Stamp Kristen Vineyard Notary Public,State of CT s �> My Commission Expires September 30,2022 Page 5 of 5 -- Z 3l/ q SOOT * TOWN OF SOUTHOLD BUILDING DEPT. ^ourm,�' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPINGWFIRE INAL DP��-] FIREPLACE & CHIMNEY SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: mvl or�-- 0� . I glvgt.,' w Il . 4 DATE INSPECTOR I4Sir� Solt _-� ij �6 A o"o✓lr Lo �� - 6„ --�17 x., 911 0 ,v6 � oo l glala0i� TOWN OF SOUTHOLD PROPERTY KC%.WKV %.Hi(D OWNER STREET I VILLAGE DISTRICT SUB. LOT rQ/�`1 Ef iC r"IIGEII gRMER OWNER , . E ACREAGE S t , J� W �/� TYPE OF BUILDING RES. r b SEAS. VL. FARM COMM. IND. CB. — misc. �1 � -- I_- I LAND ( IMP. I TOTAL DATE REMARKS Cr-r ---- .► %Ali(/ :�i J=. f 17 { 00 00, ©0 `-5' ✓ . 1�d9 7 '/I✓f fC �`�� CII L��t Esf o o �D D 17 /� � �_!_—_ l_C ._e li,,/ 1S lP5ke AGE BUILDING CONDITION ^ ----- ---------- NEW NORMAL BELOW ABOVE -710 Farm Acre Value Per Acre Value - � Til!oble i Tillable 2 � Tillcble 3 I . Woodland Swampland Brushland House Plot j - Totci ,: `° ;'•,.•..00.•;rf 'S'has:�'F• �.�•°j � 1 -t w 22.-2-32 01/30/2017 --- — - � v M. Bldg. n , _ undatioi I Bath M. v ? n ( S O 3 S O L }— Extension Base nt t\�a k3'' e Floors �c�� r`• ti 1 �r Extension Ext. W n Interior Finish oc r( Extension Fire Place Heat f '' u r a i y Porch ? ; o Attic �� _ do Porch Rooms 1st Floor Breezeway Patio Rooms 2nd Floor Garage Driveway I O. B. g�os�EFDIk� Town of Southold 12/1/2016 0 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38685 Date: 12/1/2016 THIS CERTIFIES that the building ELECTRICAL Location of Property: 1620 Aquaview Ave., East Marion SCTM#: 473889 See/Block/Lot: 22.-2-32 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/1/2016 pursuant to which Building Permit No. 41133 dated 11/1/2016 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: 200 AMP ELECTRIC SERVICE UPGRADE AND NEW RECEPTACLES IN KITCHEN The certificate is issued to Mitchell,Katy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41133 11-23-2016 PLUMBERS CERTIFICATION DATED Authorized Signature FORM N0. 4 14G�� 2�6A r r TOWN OF SOUTHOLD L BUILDING DEPAR'T'MENT TOWN CLERK'S OFFICE 1 SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. z111.2a.. . ........ Date ... . . .. ......... S-eptamber... .27....., 1962. THIS CERTIFIES that the building located atW,/8. Stars -Road & SIS Aqua SV S' AVE! Map :vo. ...St , ...... Block No. ....Q;D-;fit. i,ot 1`l0. . .. . ....gaSt• conforms substantially to the Application for Building Permit heretofore filed in this office dated .. . ......April 1a.. 19.,6,,�... pursuant to which Building Permit No. 21710 dated ..1. . 1962 , wa,., 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 ....Pr3,vata one family dwelling This cert;ficate is issued to .-aery u tehe,ll ..04mm . . . ..... .... ..... (owner, lessee or tenant) of the aforesaid building. H*D.Approval Sppt 18th, 1962 by R. Villa Building Inspector