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TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, NEW YORK
CERTIFICATE OF OCCUPANCY
NONCONFORMING PREMISES
THIS IS TO CERTIFY that the
/X/ Land
/X/ Building(s)
F/ Use(s)
Pre C.O. #- Z13534
Date- June 18,1985
located at 11725 Rt. 25 (Main Rd.) Mattituck
Street Hamlet
shown on County tax map as District 1000, Section 141 , Block 04 ,
Lot 040 doesinot)conform to the present Building Zone Code of the
Town of Southold for the following reasons:
Insufficient total area. Insufficient side yard set -back on
dwelling. Insufficient side yard set -back on accessory garage.
On the basis of information presented to the Building Inspector's Office,
it has been determined that the above nonconforming /_Y/ Land /X/ Building(s)
/_/Use(s) existed on the effective date the present Building Zone Code of the
Town of Southold, and may be continued pursuant to and subject to the appli-
cable provisions of said Code.
IT IS FURTHER CERTIFIED that, based upon information presented to
the Building Inspector's Office, the occupancy and use for which this Certifi-
cate is issued is as follows: Property contains a wood framed; two
story, one family, dwelling with an accessory wood framed garage.
Property has a Post & Rail fence down the North side of property
with stackade fence accross the rear. Property situated in the A -
Residential -Agricultural Zone with access to Main Rd.;a State Rd.
The Certificate is issued to GEORGE H. GILDERSLEEVE
(owner, }essee-or-tenant)
of the i aforesaid building.
Suffolk County Department of Health Approval N/A
UA'DERWRITERS CERTIFICATE NO. N/A
NOTICE IS HEREBY GIVEN that the owner of the above premises HAS
NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec-
tor to determine if the premises comply with all applicable codes and ordin-
ances, other than the Building Zone Code, and therefore, no such inspection
has been conducted. This Certificate, therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions.
Building inspector
FORM NO. 6 ;.1� �i �1��� rl`=t'
TOWN OF SOUTHOLD?,' m ssY K
Building Department t + 1', Y 2
Town Hall
Southold, N.Y. 11971
y
APPLICATION FOR CERTIFICATE OF OCCUPANCY
��c 31v0 �1 5sr IS`O
Instructions
�F�daoJ-
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 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 informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
Date May ....'..1985........... .
New Building ............. Old or Pre-existing Building ....K ....... Vacant Land .............
Location of Property , No #) Main Road, Mattituck.
House No.u Sneer Hamlet
Owner or Owners of Property , GEORGE GILDERSLEEVE .
County Tax Map No. 1000 Section ...141......... Block ....Q4 ......... Lot ....4Q ..........
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 $ .15:00 , . , . , , ... .. .
Construction on above described building andp mit meets I applicable codes and regulations.
C1- 3�cG� l _ BB
CO ��rS3y Applicant . G4.
GEORG GI DERSLEEVE
Rev. 10-10-78
MAP OF CERT/FY TO
DESCRIBED PROPERTY x°522 ABSTRACT Co
AT SECUR/r T/TLE 9 GU4RANTY
MA rriruc*r
TOWN OF SOUTMOL O
SUFFOI.X COMM. NEW MAW
AlwA=/4,270Sp.FT.
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FORM NO. 8
TOWN OF SOUTHOLD
Building Department MAY 2 1 I
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 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 informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00 May 1985
Date... .... ............
New Building ............. Old or Pre-existing Building ....x ....... Vacant Land .............
Location of Property (No #).Main.Road,.Hattituck.. .................. ...... .
...... .. ... .. ..
House Na Street Hamlet
Owner or Owners of Property , ,GEORGEGILDERSLEEVE
................. .... , .. . .
..... ... .... ..... ........
County Tax Map No. 1000 Section ...141......... Block ....Q4 ......... Lot ....4Q ..........
Subdivision .................................Filed Map No. ..........Lot No. .............
Permit No........... Date of Permit ..........Applicant ..................................
Health Dept. Approval ........................Labor Dept. Approval ........................
Underwriters Approval ........................Planning Board Approval ..................... .
Reauest for TemDOrary Certificate .....................Final Certificate .......................
Fee Submitted $ .15 : 00 ... .. ... .. . .
Construction on above described building a76EORG
mit meets I applicable codes and regulations.
Applicant. ... .......................
GI DERSLEEVE
n«.10 -1a78
A
3 �P:
rE MAY 2 1 19to
._. i C
f Ci'
STATE OF NEW YORK)
.SS..
COUNTY OF SUFFOLK)
GEORGE GILDERSLEEVE, residing at (No #) Camp Mineola Road,
Mattituck, New York, being duly sworn, deposes and says that:
Deponent is the owner of the house and premises on the North side
of Main Road, Mattituck, New York as shown on the survey by Sealand
Surveying & Engineering, P.C. dated April 6, 1985 attached hereto.
The house and garage have been in the Gildersleeve family for many
years and all the buildings were constructed long before 1957. No
alterations have been made since that time.
Deponent makes this affidavit to request the Building Department
of the Town of Southold to issue a Certificate of Pre -Existing Use
for both the residence and the garage.
A4V9__1
GEORGE GILDERSLEEVE
Sworn to before me this
of
May, 1985.
%day
Notary
Public