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Home My WebLink AboutZ-10892FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Build~ Impector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z10B.92 .... Date ...F. ebr~xacy. 2.4 ....: .............. 19 82. THIS CERTIFIES that the building~. ( 6, .) ........................................... Location of Property . 33?.0 .............. .W. qq~p)~ql.~t~..R. 90.a ........... .M.~.~..g.u.q .k... House No. b~raet Hamlet County Tax Map No. 1000 Section . ~ .1.4 ........ Block .. 0.1 ........... Lot . .' .0.1.1 ............ Subdivision .... ~ ......................... Filed Map No...X ...... Lot No..X. ........... Requirements for a private one-family dwelling built prior conforms substantially to the A, pts~ee~e~4'ev-ileitd~-~ammi~-tu~etofeee-~Bed-~m-el~: ~qr~e'da~ Certificat~e of Occupancy ~;~ .Apr£1.23 ........ ,1957. pursuant to which B~ias-PermR No ....... Z.1.C1892 ........ dated ..... Fe br. uar¥..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 . A ...... The certificate is issued to ..... ~.J,~ ~;L. Rr0. l).e.b.q ~ ~c~. .................................... of the aforesaid building. Suffolk County Department of Health Approval .... R/.~ .................................. UNDERWRITERS CERTIFICATE NO ............ ~/.~ .................................. Building lnsp~tor Rev. 1/81 BUILDING DEPARTMENT TOWN 'OF SOUTHOLD, N. Y. ~USI~G CODE INSPECTION REPORT Location ,~0 ~/~-~f"-/:~/-Z.~/,a~ //~o~__/ /d~7~7~Ct (number & street) (Municipality) Subdivision ~-- Map No. Lot(s) -- Name of Owner(s) Ocsupaney (type) Admitted by: Key available ( owner-tenant Accompanied by: Suffolk Co. Tax No. Date Source of request DWELLING: Type of construction Foundation ~7~.~/~ ~ Cellar~/ Total rooms, 1st. F1 ~ 2nd. F1 -- Bathroom(s) Porch, type Breezeway. Type Heat~/' Fireplace(s) Domestic hotwater Other #stories Crawl space~/ 3rd. F1 ~c~// Toilet room(s) ~ Deck, type --- Patio, typ~__ Garag~ Utility room Warm Air~-~-/Hotwater No. Exit~7~O Airconditioning Type heater ~ ~ ACCESSORY STRUCTURES: o~c/~'~ Garage, type const.~/oo~/~/~v~.torage, type Swimming pool ~_~ Guest, type const. Other VIOLATIONS: Housing Code, Chapter 52 Location Description Art. Sec. Remarks: ~ / Inspected by~;//.~ate of Insp. ~ Time start ~.'/6} end .~.'~- /,/.,~' 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 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy ~nd 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. 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 ., New Building ............. Old or Pre-existing Building(Z) X /Vacant Land Location of Property .... ,"~,~--.~..~/es tph a Ii a. Rc~ad , ~ ................. Ma. tti,tu~:k . . , House No. Street Hamlet Owner or Owners of Property... ....... William Debosk& County Tax Map No. 1000 Section ..... 1.1.q..0.0... Block .... P.I, 00 ...... Lot ...... 0~1].00 .... 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 ................. - Fee Submitted $..5.~ ....................... Construction on above described building and permit'meets all app~cable~code~,~nd regulations. Apphcant £st. STATE OF NEW YORK) COUNTY OF SUFFOLK) SS.: ERNEST WILLETT, being duly sworn, deposes and says: 1. That_J am t#e Executor of the Estate of.William Deboski, who died a resident of Suffolk County September 28, 1981. 2. Mr. Deboski was the owner of premises located on Westphalia Road, Matti tuck ,. ~ew York , 3. This affidavit is made to request a certificate of occupancy- for pre- existing dwelling be issued to your deponent, as Executor of the Estate. The house described and shown on the sur"vey attached is a one family dwelling that'{s; ~xi. matety 60 years of age. ERNEST WILLETT Sworn to before me this ~r~day of February, 1982. MARIE E. NI, cKIHLEY NOTAR~ P _.L~, lC, State of i',tew York JOHN J. MUNZEL * ATTORNEY AT LAW · 548 ROANOKE AVENUE · RtVERHEAD. NEW YORK 11901 · · -r 37z.