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Home My WebLink AboutZ-11420FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1. ! .~.2.0. ......... Date ..... J.a..n.u.a.r.y....1.1 ................. 198.3.. THIS CERTIFIES that the building ~.. ~ ) .... Location o f Property . 1. .~ ~.0.0. ...... .M.a. i..n..R.q a..d Ma t t ± b u c k House No. Stre~i ........ County Tax Map No. 1000 Section . . 1.1 5 ....... Block . .0.9 ........... Lot ...0.9.4 ........... Subdivision ...X. ........................... Filed Map No..X. ...... Lot No ..... X. ........ Requirements for a private one-family dwelling built prior to conforms substantially to the A-l:rpl'ica'tio~-for 'l~utiding 'Permit -i~reto~ore- fi}ed-in -thi's-rfffice-da'ted- Certificate of Occupancy April 23 Zl1420 .................... , 19 .~7. pursuant to which Bxri'lding-F~rrtrit-No ...................... dated ..... dia. r~ .u~a.r.y...~ .1 ............ 19 .8.3. , 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 ......... ........ ~..~. r.iy.~9.9.a~ .- .f.a.~J: .ly..d.v~ .1.1.i.n. g ~..a, qqt..a..d.e..t.a.qh.e..d./~r..a~.e.: ........ The certificate is issued to WILLIAM G. COX ..................... io~n'e'r. '/~'*'~'dXt~.t~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ...n../~a .................................... UNDERWRITERS CERTIFICATE NO ........... n../.a .................................... Building Inspector Rev. 1/81 BUILDING DEP:%RTi,~NT T0;'~T OF SOUTHOLD, N. Y. HOUSING CODE INSPECTI01¢ REPORT (nmmoer & szreev) Map No. / Occupancy ~A/ ~ ~/ (type)/ Subdivision Admitted by: Key available Source of request ?C con~p3_n~ ~d (M~nicipality) Lot(s) owner-tenant 'by :, ' SurroZk co. No._/r 5/' Type of construction Foundation Total rooms, Bathroom(s) Porch, type -~ Deck, Breezeway ~ Garag~ Type Heat ~.~ Warm Air Fireplace(s) / No. Exits Domestic hotwater.~ zz/~% Other #stories Cellar ~g( Crawl space... 2nd. Fi ~ 5rd. FI Toilet room(s) ~l~ ~ type .... Patio, type Utility room Hotwater Airconditioning Type heater ~_~ ACCmSSORZ STRUCTURES: Garage, type const. Swin~ming~o ol 0 ~h er /~ · ~/v Storage, type const. - Guest, type const. -- VIOLATIONS: Housing Code, Chapter 52 ~Location l Descriotion Art. t Sec. Remarks: Inspected 'by: .,~ ~--~,'~ Date of Insp. ~/' f /~,-~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 app"oval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Onderwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, 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. 8. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ail 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 informa- tion 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 New Building ............. Old or Pre-existing Building ....X. ....... Vacant Land ............. Location of Property../~...-~...~..~. ..... .H.a.~.n...R.o.a.~ .................... .M.a.~ .t.~.'c.~.?~. ...... House No. Street Hamlet Owner or Owners of Property . . .W.. ~..[.[.~.a.m...G....C. 9.x ......................................... County Tax Map No. 1000 Section .... 1.[..4 ........ Block ..... .9 ......... Lot ..... .4. ......... Subdivision ...... ~/~ .......................... Filed Map No ........... Lot No .............. !? Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... ,X, .............. Fee Submitted $..5.: .0.0 ....................... Construction on above described building and permit m~et, s all applicable codes and regulations. ,~'~ Applicant ..... W~..~(~.~..' ......................... STATE OF NEW YORK: : ss. COUNTY OF SUFFOLK: WILLIAM G. COX, being duly sworn, deposes and says: That I am the owner of a parcel on the south side of the Main Road, Mattituck, New York (Suffolk County Tax Map No. District 1000, Section 114, Block 9, Lot 4). I acquired this parcel on May 3, 1973 from my parents, Ralph Cox and Iola B. Cox (Liber 7392 Page 276). Located on the property is a two-story frame house and an attached tool shed which has been used continuously as a residence since 1900. Also located on the premises is a separate garage. The house is in good condition and all of the buildings have been constructed prior to 1957. The application is made for the purpose of obtaining a Ire-existing Certificate of Occupancy from the Building Department ~f the Town of Southold. William G. Cox' Sworn to before me this 25th day of October, 1982. Notary Public BARBARA DIACHUN Notary PuI~c, State of New York No. 52.4635190 Suffolk County Commission Expires Ma~ch 30, 19~'~