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Home My WebLink AboutZ-9924FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Date ........... &~$1. X~, ........... 19 8.0 THIS CERTIFIES that the building ................................................ Location of Property . .4.$.~.~.. 0~ .~9.n...1~..~.~.,..Ma..~.~.$gll.O~ ............................. House No. Street Hamlet County Tax Map No. 1000 Section ....~.~. ...... Block .. 00.], ......... Lot .. 001 ........... Subdivision ............................... Filed Map No ......... Lot No .............. dated ...Ap.r.],l. 1.8. ~ ............... 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 ......... The certificate is issued to Vet& Berl~olk~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~/,R .................................... UNDERWRITERS CERTIFICATE NO ........... N/.R .................................... Rev 4/79 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. HOUSING CODE INSPECTIONREPORT 4835 Oregon Road (number & street) Vera Berkoski Location Subdivision Name of Owner(s) Occupancy R-1 (type) Admitted by: Self Key available Celic Agency Source of request Map No. Mattituck (Municipality) .Lot(s) Unoccupied (owner-tenant) Accompanied by: Self Suffolk Co. Tax No. 95-1-1 Gary Flanner Olsen Date 4/9/80 DW-~.LING:. Type of construction wood framed Foundation Poured Concrete Cellar Total rooms, lat. F1 5 2nd. F1 Bathroom(s) 1 Porch, type roof over Deck, Breezeway Garage Type Heat Oil fired Warm Air Fireplace(s) No. Exits 3 Domestic hotwater yes Other #stories 2 full Crawl space 3 3rd. F1 large attic Toilet room(s) 2 type Patio, type Utility room XX Hotwater kX ..AirconditioninK Type heater tankless ACCESSORY STRUCTURES: Three (3): Shed: Garage, type const. 3-car/wo0d ~EH~B, type const. Swimming pool Guest, type const. Other Large old sto~age barn/wood .. wood VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Outside C~llar doors broken Outside Some wood shingles need repairing III 52-31-B Outside All three brick porches need repairing- bricks loose Outside COl~lmn front porch ~n ,' IITT 52-30-A Outside House needs paintinq badly ._ III 52-30-31 Accessory Structures - all need reDairin~ badly: door~. windows, sills~ foundation, roof qone in III 52-30A~C and p~ces 52-31B-C Remarks: Inspected by:~Date of Insp. 4/17/80 Curtis Horton Time start 4~15 end,.a9 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. Submit Planning Board approval of completed site plan requirements where applicable. existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" uses: i. Accurate survey of property showing oll property lines, streets, buildings and unusual natural 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 o certificate. Certificate of occupancy $5.00 ~,LO~ Certificate of occupancy on pre-existing dwelling or land use $5.00 Copy of certificate of occupancy $1.00 / Date.....~.t....~..I..~..~ ........................ .uJlding ................ Addition ................ Old or Pre-existing Building .....~... ..... Vacant Land .............. 0~-ocat~on Of Property ........ .~.~..~ ....... ..~.;..~.~..~..~..~ .................................... Own Or Owners Of ...~.~.~.../~tg~..~.~..~e~.~..~.~,.S ................... ..~ -- C-~b,~;,.sion ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate .................................... ~ Certificate ...... ~. .............................. Fee Submitted $ ...,~.~ ................ Construction on above described building and per licable co~Je~n~regulations.~/- , Applicant .......... ~.~: ............. / .............. Sworn tobefore me tl~ .............. day of '*'~7/" ...................... (stamp or seal) Notary Public .................................... County 0 ¥) C~ d ~n Oitrt': (000, ~e~/-, 09~,, Block./, ,°~rc~l l. CO~ q