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Home My WebLink AboutZ-6969FORM NO, & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~/.$. N~. ~o. 8~l ............ Street Map No. '" ........ Block No..X~ ...... Lot No~.. I~[att~t~k...N. ,~.o .......... conforms substantially to the built _ ~:_LC~f_lq~te .9~. oeeupaney dated . before..Apr-- .~. -., 19. ~7. pursuant to wmcn 1~4o. Z6~Y9 ' ' dated ......... April.. i) .... , 197t., 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 . Prtvats .oao..faUl~;Ll.y. d~lllin[ ....................................... The certificate is issued to (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval p.rl.-..~..ILA..I.~...:i~ .................... UNDERWRITERS CERTIFICATE No.. p~.~-~ .~3ctsl;in~ ........................... HOUSE NUMBER ..... .1.1700... Street .... Nai]~ .l~Oa.(l... N~l;1.t.xl~][ ............. HOUSING CODE INSPECTION April 8, 1976 11700 Main Road R-1 Mattituck, N. Y. Tax Roil: Sylvia Barnes & Ano. Occupied, Owner U~on receipt of an application for a Pre-Existing Certificate of Occupancy, I made an inspection of this one and partial two story framed dwelling. I was admitted to building by Mrs. Barnes and began inspection at approxi- mately 10:25 A.M. First floor consists of a family room, living room, dining room, kitchen, two bedrooms, laundry room, and a full bathroom. The second floor has two bedrooms and full bathroom. Heat is furnished to first floor rooms with the exclusion of the two bedrooms from an oil fired warm air furnace located in partial cellar. The following violation of the Housing Code, Chapter 52, Town of Southold, was found: Stairwa~ to second floor, no means of controlling light for safe ascent, Article II, Section 52-26 B.3. EH:mm Inspection completed at approximately 10:45 A.M. ~~Re ectfull, submitted, Building Inspector FORM NO. 6 TOWN OF SOUTHOLD o 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 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, anci 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 19§7), 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 ...4./...7../..7...6. ................................ New Building ................ Addition ................ Old or Pre-existing Building ...X...X. ......... Vacant Land .............. Location Of Property ..... S/~..s...i..d...e.~..q.f.....M..a...i..n.~..~.q.a..d..~.~..~p~.~;~.~.~.~.~;.'~.~.~ ................................... Owner Or Owners Of Property ,~3.~.V..~..a....~,.P,.r...n.f~.....a. TLcl..J.~,C.qP,.~.~,~,D,f%..~Q~ ......................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate .......... 2{ ............................. Fee Submitted $ ..... ~0~ ..................... Construction on above described building and per~/~..~./O~~~nd regulations. Applicant ........... ~/~.~..~r:.....,,,- ........................................... Wil~/iah~ W~c~h~m~Wickhaf~ & Lark,P.C. ) Sworn to before me this ....7..t..h.. ...... day of ....A.]p..r..i...1. x....1..9...7..6. ............... JoAN HlNf~'eJ~[~r seol) Public ..... $.uf~o/.k...~ .........County ae'r,l~¥ PUS[lC, Notary Ne. Title No. So;~?~]561 Z NOTE' m= MONUMENT SURVEY FORi SYLVI'A BARN~ES,PAUL D. ~ JACQUELINE W. COX MAT~ITUCK ~ TOWN OF SOUTHOLD SUFF. CO., N.Y. SCALE' I"= 40' JAN. II, 1967! GUARANTEED TO; NORTH FORK BANK AND TRUST CO. SECURITY TITLE 8 GUARANTY CO. P R 0 F E SS IONA"~-/ENGI NE,~ R AND LAND SURVEYOR, N.Y,S. LIC. N0.1284§ RIVERHEAD~ N.Y.