HomeMy WebLinkAboutZ-4856 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.~.~e54....... Date Oct 16 19.72.
THIS CERTIFIES that the building located at . 1t,/Q . $rgA4. ~er~gr. RQ Street
Map No.. Cspt . >Cldd Block No........... Lot No. px..I1~}. 8~ s M.attit~k.. 1Q •Y.. .
roq resents for ono faASilq dwoll dk additieN to
conforms substantially to the
sass 4 lwssing Dodo Cortilioste o! ooaxpsna!
~.Be.toro. ,april..23..., 19.57. pursuant to which ~ o
~ ~a56.. .
ions 8/61.. c/oi 289 & " E~4_c/o ?015
t . 1~5-.... , 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 PatiVa~.e .one..faml.l.g. da~slll.ng .
The certificate is issued to J'pj~yn.$$,q~.......OtJ31ar . . . .
(owner, lessee or tenant )
of the aforesaid building.
Suffolk County Department of Health Approval F'. -'.-'e..exi stingy
UNDERWRITERS CERTIFICATE No......;:re...eX19xi.n6 .
HOUSE NUMBER.'1000.......Strcet...Sp]UI1d.~.e.SCh.~.2'11M
Building Inspector
FOHd!{ NO. {
TOWN OF SOUTNOLD
Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instwetions
A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 dispcsal-(S-9 form or equop.
3. Approval of electrical installation from Boo rd 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 $5.00
3. Copy of certificate of occupancy $1.00 g t 29. 1972
Dote ......°P
New Building Old or Pre-existing Building ...........X............... Vacant Land
Location Of Property ....212.S~oustd..Heaah..Ih:iue,...Mattituak~..N.Y.
Owner Or Owners Of Pro ert John E. Egan
P Y
"Ma of Ca twin Kidd Estates" & Parts of k~
Subdivision ........P...........p
.......................................Lot No....~:5..... Block No............. House No~l~~®
Permit No Date Of Permit ....................Applicant
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning Board Approval
Request For Temporary Certificate Final Certificate Sii~J7K..Aae..............
Fee Submitted $ 5.00
Construction on above described building and permit eets al app ' able codes and regulations.
Applicant /.1.
Sworn to before me this v i ~ 7
,o,~
,,,,,~Oth„. day of ...S~e~pte¢nhen..].9.72 (stamp o~aq j~~ ~ S ~o
Notary Publ~{~....A~.......~.`.~,.,.... ~punty ,p [ C
Ii11LLINM J. CLA@W \ (J'tf-~
~ Publlc, EhN of N{M ~k ~ ~ ` ~L~
No. 305712500
Qualified in Suffolk County (p~
Term Expires March 30, 198 /L
HOUSING CODE INSPECTION
October 16, 1972
1000 Sound Beach Dr.
Mattituck, N.Y.
Tax Roll: John E. Egan
Occupied
Upon request of .the Southold Town Building
Department I made inspection of thins one story
framed dwelling and found the following violation
of Local Law #1, Housing Code of the Town of
Southold. I was admitted to kitchen entrance by
Mrs. Egan and began inspection at approximately
12:00 p.m.
Kitchen - Gas range, no shut off valve at
unit - Section 508b.
Inspection completed at approximately 12:10 p.m.
R ctfully su mitted,
i
ward Hi dermann
Inspector
EH:tle
State of t'ew York ss
County of Suffolk
John E, Egan, being duly sworn, deposes and says:
That I reside at 212 Sound Heach Drive, Piattituck, New York
and I am the owner of the said premises since raay 6, 1952,
Since that time the said premises have been occupied and used
solely as a one family dwelling by myself and rr{y wife Helen Egan,
That the building erected bn said premises has been and is
in good condition.
Jo Egan r
Sworn to before me ,7
this 29tnh~day of S/e/p®t. 1972
INWt J. N.Aii.~
Blf/Mty Pubue, Strati of Naw York
M+a. 3A~b712b00
Qualified in S~:ffotk County
~E(.rFl Ezp!res March 19~~
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