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Home My WebLink AboutZ-5407FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .~.0.? ....... Date ............ ~ .~g.....28. ......, 19. THIS CERTIFIES that the building located at .~//.8..L0~.~. La..n~.. &..g...R27 .... Street Map No. C. ~..ReeV?.. Block No ........... Lot No ............. . .~.t..t.~.t.u. Ck...N :.Y.°... require~ents for one family dwelling conforms substantially to the .z~r?,~a,~ built beforeA ril 23 gertif$cate of occupancy dated ......... P ............ , 19.~?. pursuant to which ~[~~No.Z .~0~. dated ........ Allg.. 28 ...... , 19.73., 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 .. Pr!.¥ .a~.®. .o.n.e..f .~..~.l.y.. d.v.e.l.!~ng ...................................... The certificate is issued to . .Cha.r.l.e.s. .~,.br.a..h~l...· ..... . .~..e.r. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .P~'e~'..e~L.~..~t;i~g ................... UNDERWRITERS CERTIFICATE No. 1)~'~. ~.:~,l~.t.t,~ .............................. HOUSE NUMBER.~01+' .1~0~.~ ...... Street...C.I~ .lOVe ~'~ ................................. . . . . . . . . : .-/ .......... Building Inspector [ FORM NO. 6 TOWN OF $OUTHOLD 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, 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ...........?..2.......1 .......... New Building .................... Old or Pre-existing Building ..... ~ ................. Vacant Land ............................ Location Of Property .... .~j../.~....~...o.~..e.....~...~..~..e. ........ [,.~.~.~.1;.~.~.~,.(;.~ .................................................................... Owner Or Owners Of Property ..... ~.~,~,~,q...,~.Z'~..s ............................................................................ Subdivision ............... .O...]:.~..~..a,....~..e...a..v..e.. ...................... Lot No ............. Block No ............. House No ............. Permit No......]rr~... ............ Date Of Permit ..,~-~:. ............ Applicant ..~cZ(~t~...~.Z)J~.zat~.a .................... Health Dept. Approval .......... ~.~.e..~....~..~..~.s...t;..:J:.~.C....Labor Dept. Approval ........ ..~..:~.; .............................. Underwriters Approval .... ..~.~.e..-...~..~.~..~..~.~.]fi~ .......... Planning Board Approval ..... ]~.,~^ ......................... / Construction on above described building anfl Applicant ....... Sworn to before mexth~s Notary Public .......... ~ County Request For Temporary Certificate ..................................... Final Certificate .......~ ............................. Fee Submitted $ .. ~...,..0.~ ......................... ~~~ ~)er aJ~ Iic I codes and re lotions (stamp or seal) CATHLEEN C. ROBINSON Notary Public. State of New Yore Qualified in Suffolk County No. 52- 3308529 _,/ Commission Expires M~rch 30, 197_.~ TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER l ?rREET VILLAGE f DIST. SUB. LOT ~:- FORMER OWNER N E ACR.' S W TYPE OF BUILDING / RES,,,~/O SEAS. ~IVL FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS/Z/t/d// ] , AGE ~ BUILDING CONDITION NEW NORMAL i BELOW ABOVE FARM Acre i Value Per Value j Acre Tillable 1 i Fillable 2 Voodland j ;wamplond J FRONTAGE ON WATER Irushland ] FRONTAGE ON ROAD louse Plot DEPTH BULKHEAD STATE OF NEW YORK COUNTY OF SUFFOLK says: CHARLES ABRAHAMS, being duly sworn, deposes and I am the owner of certain premises at Mattituck, Town of Southold, Suffolk County, New York, on the side of Love Lane, more particularly shown on the annexed survey of Roderick Van Tuyl, P.C. dated August 13, 1973o The one story frame house and shed as shown on said survey were erected prior to 1957 the date of enactment of the Southold Town Zoning Ordinance. Said stz~ctures have not been altered in any way and same are valid non-confoz~ing buildings erected prior to the enactment of said Zoning Ordinance. NatalT Public, State of New Yor~l _ No, 52-2637425, Suffolk C~un~t~ ~'~ ~mmi~ ~1~ ~ 30t t~~