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Home My WebLink About1000-144.-1-15 � � � 'OWN OF SOUTHOL t Rental Permit 0766 Owner Steven Crom Occupied as Single Family Dwelling Located at 1980 Sigsbee Road Laurel 144.-1-15 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. kl' 10/28/2024z C ) 2?1-� Code Enfo cem Official This Notice must be posted by the main entrance at all times fjf so TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 /VV-/-/�r INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ 1RENTAL sod a"c u DATE /�.ash a� INSPECTOR TOR S�f FOIk Town Hall Annex Town of Southold 54375 Main Road 7-21 c Rental Inspection Report PO Box 1179 Southold, NY 11971-1179 ip Tel: 631-765-1802 SCTM.# �?' .,. � Date... . �... /d . Owner . .. ..m. .. .._. ......... _.w .... ..__. ._ ._... _. .... Phone.. ....�._.... . _.. ... Address ( Visible } ., .. .._ p �. ..... _.._._.. . .._... . M . __. . . . _ Hamlet j Inspector j .pies Sub 1 I 2 3 � ;.Floor Level Quantities ..�.�._.. rv. _a_..�. , __........,. ...�_.... .�... .� ._..mm a..� ....�.�_�..,_... .. uantit ( bedrooms) in bedr . ,Smoke De.��. . �.,..wnot located ._., Carbon Monoxide Detectors 1. .... 1. _..... Fire Extinguishers _ ... ...� Exits .._,..,....' _n Bedrooms 1 2 3 4 5 6 Smoke Detectors I �/ Egress _ ...... _. .. .. . . Occupant Count J Building Systems Maintained &Operational Condition of Property Heating.. .-� ..e ... ...w.., . ,., Building int.��..erior Hot w..._� .r ..._ ,. ... ....a�... .. .... ....�.. __ .k,..�_ .. �-._ . ,........ .n..._e �....._..a, -.. . .......�_ _.._.a ..w � .. ...�o....w� m ,.....w. ater I Building exterior Electrical Property clean, maintained &safe Mechanicalguards installed & se ._ ..W....__ . ., .,. � . cure Handrails &g... . .e _�....,_ ... ....w .�_w,..._.. ... ..... �.� n._.. Pool Safety Pool on Site Surface water alarm _ Date of CO issuance Door alarms � W P_.00l completely enclo. se..d Self closing latching gates Pool fence to code requirements o's for all items present Prior Rental .Comments: � e TOWN OF SOUTHOLD E Rental Permit 0766 Owner Steven Crom Occupied as Single Family Dwelling Located at 1980 Sigsbee Road Laurel 144.-1-15 Maximum Permitted Occupancy 4 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. 11/1/2022 derrorce erg tial This Notice must be posted by the main entrance at all times —4 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD U RENTAL PERMIT APPLICATION BULc W46 UtP L TOWN OF S,�,,UrW.., Rental Permit Fee$200(Application must be renewed every two years) Section A. Property Information: Rental Property Address: .: .. R . Tax Map Number: 1000 SECTION I �� -BLOCK -LOT - SECTION B. OWNER INFORMATION: Property Owner Name: G N v Property Owner Legal Address: Property Owner Mailing Address: ?�4 1 Telephone Number(s): Daytime Evening Emergency Property Owner Email Address: .G Page 1 of 5 jj Town Hall Annex ; Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SO SOLD Section C. Authorized Agent Information: M Name of Authorized Agent of dwelling unit, if any: ANN0— t1"F'T" 1 ►�- Cpm Address of Authorized Agent(no P.O. Boxes): � - Mailing Address of Authorized Agent: Telephone Number(s): Daytime Evening Emergency Email Address: 1 K C'Y'L-1 ? K -i L— Section Gip 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): Page 2 of 5 SOVA Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1 179 CIS Southold,NY 1 1971-0959AVA w � BUILDING DEPARTMENT TOWN OF SOUTHOLD Mailing Address of Managing Agent: Telephone Number(s): Daytime Evening Emergency Email Address: SECTION F. PROPERTY DESCRIPTION: Number of Rental Dwelling Units on property: A::::�. ._ 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 Unit: Number of rooms in Rental Dwelling Unit: Use and Dimensions of each room in Rental Dwelling Unit: Z I12 l as "" M illi NNit� lLO 31�o Page 3 of 5 s } Town Hall Annex &,, Telephone(631)765-1802 54375 Main Road �1 Fax(631)765-9502 P.O.Box 1 179 scr Southold,NY 11971-0959 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. am requesting a fire safety inspection to be performed by a Code Enforcement Official from the Town of Southold ❑ 1 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. STATE OF NEW YORK) ) COUNTY OF SUFFOLK) Icertify 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 Page 4 of 5 01 Town Hall Annex Telephone(631)765-1802 5437.5 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ^ BUILDING DEPARTMENT TOWN OF SO HOLD 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: Property Owner's Signature: Sworn to before me this day of '10 L4 ------------ 20?- 2— Official Notary Public Signature and Original Notary Stamp MARYDIANAFOMM NaWy Pubhoj Stift of Now 2'0* .52-465524 0AMed in Bek o eotntnis�Expires, uuoi.2* Page 5 of 5 r4SOIJ , Town Hall Annex Telephone(631)765-1802 54375 Main Road CA Fax(631)765-9502 P.O.Box 1179 �� Southold,NY 11971-0959 eou BUILDING DEPARTMENT TOWN OF SOUTHOLD RENTAL PROPERTY CERTIFICATION Form is to be completed by a license architect, licensed engineer or licensed home inspector Separate form is required for each individual Rental Dwelling Unit Professional seat required for,Architect or Ea ineer license Home Inspector must provide My o 'valid current certification Rental Property SCTM Number: Rental Property Address: 0 " ' IJS 2. Owner/Name: Rental Dwelling Unit Identifier: Number&Square footage of each bedroom as depicted in the attached floor plan: (i.e. Bedroom#1-100 sq., Bedroom#2-90 sq., etc.) Property Description (Include all improvements indicated on survey) I certify that I have done a physical inspection of the subject rental dwelling unit and find that it fully complies with all the provisions of the Code of the Town of Southold,the Residential Code of New York State,the Building Code of New York State,the Plumbing Code of New York State, the Fuel Gas Code of New York State, and the Energy Conservation Construction Code of New York State. Print Name and Title Original Signature Please place professional seal: E E OUT OL4 BUILDING EI 6311 -7654802 INSPEC ION [ ] FOUNDATION IST [ ] ROUGH PLBG. I l FOUNDATION 2ND [ ] INSULATION/CAL [ ] FRAMING / STRAPPING [ ] F` L [ ] FIREPLACE & CHIMNEY M EIRE SAFETY IN% [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PEI [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (Fit [ ] CODE VIOLATION [ ] PRE C/O REMARKS: WA n III, to Y=,� DATE w, INSPECTOR 0 rm /, ii 6„ � rC)(Y� .-TOWN OF SOUTHOLD PROPERTY RECORD C1 OWNERTREET VILLAGE DIST SUB. LOT x _ FORMER OWNER N E ACR. _r S W TYPE OF BUILDING a i RES. ; .� SEAS. VL. FARM 1 COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS D LO 3 E a Qy IDI NG CONDTIQ,N NES`d ! NORMAL BELOW ABOVE = a g FARM Acre Value Per Value Acre Tillable 1 litTillable 2 Tillable 3 Woodland e , Swampland f FRONTAGE ON WATER Brushland FRONTAGE ON ROAD E 5 House Plot DEPTH ' BULKHEAD co s s� Total DOCK �/ �" Co )LO R �= ' f ►} I 3 � t i I P I 4T :IM z I r - _ ' ---------- I r #--ii i J 144.-1-15 3/6/2019TH • - a ` 'Foundationth i e i J Ba Dinette F i Extension Basement Floors = K. i 1 � Extension E Ext. WallsyI") Interior Finish LR. Extension Fire Place Heat F I DR. C_ I I AjG Type Roof Rooms 1st Floor BR. _ I Porch • Recreation Roo 'I Rooms 2nd Floor FIN. B i,(, 'Dormer 0� � - _ i Driveway I I Garage Patio i E } O. B. i Total s Town of Southold 9/15/2022 ��ItQ1A �. 53095 Main Rd o Southold,New York 11971 PRE EXISTING CERTIFICATE OF OCCUPANCY No: 43413 Date: 9/15/2022 THIS CERTIFIES that the structure(s)located at: 1980 Sigsbee Rd,Laurel SCTM#: 473889 See/Block/Lot: 144.-1-15 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- �_.."43413 MMµMm dated 9/15/2022 was issued and conforms to all the requriements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ryooci.. tan single I" i i-ly dy+ l nn th in jnisshgc basement, ; The certificate is issued to Crom, Steven (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. oi BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 1980 Sigsbee Rd,Laurel SUFF.CO.TAX MAP NO.: 144.-1_... .....ww .M_...... .u...... ..�.�.�.�.�.�.�.�.�.�.�.�.�.�.�.�.�.�SUBDIVISION:15 .....__..........._............._. - _--------- ..........�w�_._ �_� �..... w..�_..�.�.�............_.__� _,�. NAME OF OWNER(S): Crom,Steven w_.... .,__�__--------........ - ......... ...._w......_...........M.M.mm..._.....m...............w _._..........._._. OCCUPANCY: ADMITTEDBY:�.�.w_�.�.�.�.._..�.......�._...�..w_._._._.......�..w_�_�_�_�_�__.........m.w�w�_�._._._ .._.�...�w_......................_........ ....._�..__..._�_.....�_�.._.....,.�_...............,.��www.�.�..._. SOURCE OF REQUE ..._.._..........._._._....,...w............................................. _ ST: Bail, amuel DATE: _9/15/2022 S w.�w...........w_......... ._.......... ..... DWELLING: #STORIES: 1 #EXITS: 3 FOUNDATION: cement block CELLAR: full CRAWL SPACE: BATHROOM(S): l TOILETROOM(S): UTILITY ROOM(S): yes ._.........._ _�_..wwwww w_............. ._............_............_...._.... __._. PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: yes TYPE HEATER: gas AIR CONDITIONING: TYPE HEAT: oil WARM AIR: forced hot air HOTWATER: -......,--.--w_�.w..........ww_ #BEDROOMS: 3 #KITCHENS: 1 BASEMENT TYPE: OTHER: ACCESSORY STRUCTURES: GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: SWIMMING POOL: GUEST,TYPE OF CONST: OTHER: VIOLATIONS: REMARKS: INSPECTED BY: JOHNJ DATE OF INSPECTION: 8/30/2017 TIME START: 9:33am END: 10:23am Town of Southold 8/24/2018 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39867 Date: 8/24/2018 THIS CERTIFIES that the building RESIDENTIAL ALTERATION Location of Property: 1980 Sigsbee Rd,Laurel SCTM#: 473889 Sec/Block/Lot: 144.-1-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/21/2018 pursuant to which Building Permit No. 42418 dated 2/28/2018 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: ADDITIONS AND ALTERATIONS_INCLUDING SIDE ANDREAR WOOD LANDINGS AND OUTDOOR SHOWER TO AN EXISTING ONEFAMILYDWELLING AS APPLIED FOR, The certificate is issued to Crom,Steven of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42418 08-13-2018 PLUMBERS CERTIFICATION DATED 08-10-2018 Henry Smith - www .. __......................................... . _... ....................... w ww ........... .w io ,ed Signature ' "., Town of Southold 1/31/2021 P.O.Boz 1179 "e 53095 Main Rd ` q Southold,New York 11971 CERTIFICATE OF OCCUPANCY 'ANCY No: 41806 Date: 1/31/2021 THIS CERTIFIES that the building ADDPTION/ALTERATION Location of Property: 1980 Sigsbee Rd, Laurel SCTM#: 473889 Sec/Block/Lot: 144.4-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/22/2019 pursuant to which Building Permit No. 43596 dated 3/28/2019 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: alteratz � . . at�orts ir�cludirr� eovered�c�rrc�rdkr side stota a��d ter stoo to ars eisttt oa�e fpally 11r for per 7-13,x.#7240 dt :c1211f219. The certificate is issued to Crom, Steven of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ............ ._....._..wwww........................w A_.....i rir d ignaturre .,m....w_ w � FORM NO. 4 d„ "AA 4t TOWN OF SOUTHOLD. BUILDING DEPARTMENT" TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.Z. .3 3A8. . .. . Date . . . . . . . .December. . 17,v. . . . . .. 19 68. THIS CERTIFIES that the building located at Si,galMe.Road . . . . . . . . . . .. . . . Street Map No. Mattituck Block No. . . . . . . . . . . .. Lot No. 4Q.,. .MattAturk.. mew. .YQ.xx.. . . . Perk conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . . . Deceember. . .12.,. ., 1968. pursuant to which Building Permit No. 4154. 2. dated . . . . . .Dtecembox . . 12,. ., 19.68, wa s 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 private. one .family.dwelling.with .gaa ags . 4acceeeoxy. building) The certificate is issued to . . . F.rance.e .Bali.. . . . . . . ... . . . . . . . .. .. . . .. . (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval . . . . , . . . �. .t,�..!. . . . . . . . . . . . . . . . . . . . . . Building Inspector FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. . . .Z10681 Date . . . . , .8eptember 11. . . . . . . . . . . .. 1981. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . • . . . . . . . . . . . . • . . Location of Property1.M. .S1�;�bge. R.o.4Sl,. . . �,&urel,,, ,New, ,]�Qrk , , , House No. 8treer Hamlet County Tax Map No. 1000 Section , .144. . . . . . .Block . . . , 1. . . . . . . . .Lot . . .815. . . . . . . . . . . Matt. Park Prop. Filed Ma No. 80 . . , . .Lot No. 40 Subdivisio p . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated , , , Aupps t .7, , , , , . , , 19 ,8 pursuant to which Building Permit No. . . . . .�?323. Z , . , , . , dated August 10 , , . , , . . , , _ . I 1, , ,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 . . . . . . . . , Accessory. (Coal. Bin?. . . . . . . . . . . . . . . . . . . . . . . . . . . . „ . . The certificate is issued to . . . . J-eAn. WX4 .FrAnCO-S- 3011. . . . . . . . . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval . . . . . . N/R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. R UNDERWRITERS CERTIFICATE NO. . . . .NIR. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . Building Inspector Rev.1/81 q Y FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,.N.Y. Certificate Of Occupancy No. Date . . . . . June. .1.1 . . . . . , . . . . . ., 19 82 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . » . Location of Property 1X80Si shee Road„ » , , . . , , , , , , . ,Laura]. House No. Street Hamlet County Tax Map No. 1000 Section . .1.4 . . . . . . .Block . . 01 . . . , . . . . . .Lot . , Q!5, . , , , , , , , , Subdivision . .t uC kc. �.ax'k�. .F.r 9 P Qx.t i Q 47iled Map No. $R 1 . . . .Lot No. .4 P. . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated , ,VPAru4Lry. ,2�. . . . . . . 19 AZ pursuant to which Building Permit No. A15?Q4 . . . . . . . . . . . . . dated . . .FPAY!uQry, ,24, , , , . , , , , , . . 19 82. ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . .At. . . . . . u�.1, . 9)zA� t�.QA .upder an ,existing one-family .dwelli.ntr.. . . . . . . . , . » The certificate is issued to . AFrAnAg5. RA1T. A ,0r q towner,/ « � ' of the aforesaid building. Suffolk County Department of Health Approval . . n/r. « . . . . . . . . . . . . . . . . . . . „ . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . .n/r. . . . . . . . . . . » . . . . . . . . . . . . . . . . . . . . Building Inspector Rev.1/81 do x FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hill Southold,N.Y. Certificate Of Occupancy No. . ?l P?$ . . . Date . . . . . . .Jung 1 1 . . . . . . . . . . . . . . . .. 19$2. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . Location of Property ? Q. . . . . . . . . . . . . . S qig pe Road * µ w Laurel House No. y County Tax Map No. 1000 Section .144w . . . . . .Block . .Q]. .. . . . . .. . .Lot . .015.. . , . . . . ., . Subdivision t44ttit99k Park, PropertiesFiled Map Na. $Q?. . . . .Lot No. 4.. . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated F @ p p uA r Y. 931 . . . . . . 19,'!?.pursuant to which Building Permit No. ? 15.71 . Z. . . . . . . . . . . . . dated . . F e b r LIAr.Y. 2,4. . . . . . . . . . . . . 19 .$?,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 . . . . . . . .. am. acces04.4ry. S.t4i'�kxe .building•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to of the aforesaid building. Suffolk County Department of Health Approval . . . . . .fij r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . n1r. . . . . . . . . . . . . . . . .. . . . . . . . .. .. . . .. . Building Inspector Rsv.1/81 ...r_. FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .Z1,489.7. . . . . . . . . Date . . .September. .l$.►. . . . . . . . .. . . . .. 19$6. THIS CERTIFIES that the building , deck & side cellar entrance addition. . . . . . . . . . . . . . . . . . Location of Property , .I?S? Sigsbee Road MattitYuck, N.Y.. 1.1o�xse P4lt�. Sheet � �N,±'ernlei' County Tax Map No. 1000 Section . . . 44 . . . . . .Block . . . P.1. . . . . . . . , .Lot . . . . . .?5. . . . . . . . . Subdivision . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . . conforms substantially to the Application for Building Permit heretofore filed in this office dated 14.4y.5... . . . . . . . . . . . . . . 19$6. pursuant to which Building Permit No. . .1.5.091. .2 . . . . . . . . . . . dated . . .J,Q 1.Y. .1.6 . . . . . . . . . . . . . . . . . 19 .8 6,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 . . . . . . . . .. deck, & side. cel,l,ar, entrance .add.ition. ,to, an ,exi,stinA ,one, ,family, ,dwe,lling. The certificate is issued to , , , , , ,Francis Bail &, ors . . � ! , , , , , , , , , , , , , , , , , r . P`oa�ner, att', of the aforesaid building. Suffolk County Department of Health Approval . . . . . . „ . . N/A 1 . . . . . . . . . . . . . . . . . . . . . . . .. . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . .N/A M M . . . . . . » . . . . . . . .. . . . . . . . . . . . . . . , . » . . . . . . . . . . . . . Building Inspector Rev.1/81 b