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Home My WebLink AboutZ-15521FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ,Pre. CO .Z 1 552 1 Date , , , December..1 8, 19. 86 ., THIS CERTIFIES that the building , 0 n e , family , dwelling with , addition 55 North Dirve Mattituck, New York Locationof Property.. ........................ .. ...................... . . Hous.e lVo. Street 'Ham%t County Tax Map No. 1000 Section .. , 10,6 , , , , ,Block ... 0 6 .......... Lot ... 0.16. *.0 0.1 ... , , M/o Shore Acres 41 19P,20P,21P Subdivision ..............................Filed Map No. .... ..Lot No. .� ... . . Requirements for a private -one family dwelling built conforms substantially to theii�t�o��c�uilati�a��Paecite�e#o�m�xfdbed�dtsii�xted prior to Certificate of Occupancy A p r i l 23 .. 19 .5 pursuant to which l i ig RUIN X 2 1 552 1 dated December 18, 6 ....... .................. 19... , 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 one.... . .f.amilpp dwelling with addition as applied for under Building Permit #109932 dated November 29, 1980, issued Dec. 9, 1980 & Certificate b'f-Oc'c'dpainc'y 'Z7'1'4'63' 'i-eddtii"Fdb'rV1ty• 4'; "19.8'3: ... , .....• . , .......... , .. . The certificate is issued to . , . , , , , , GERARD P. . l GOEHRINGER .. . . .. . . .. . ...... . (owner, of the aforesaid building. Suffolk County Department of Health Approval . , , . No ....record • pre .existing ...... • . . UNDERWRITERS CERTIFICATE NO...... , . , , , _ N o..r e c . r d ......pre .. x i s t i n g .................. UNDERWRITERS CERTIFICATE NO. Rev. 1/81 N591753 (addition) Building, Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 — 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted 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 p-mperty 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 5.Updated C.O. $15.00 Date ... 12/16/86 ... NewConstruction. , , , , , Old or Pre-existing Building ............ Vacant Land ............. Location of Property... , Nor t h , Dr * i ' ve , ..... , . .Matti t u c.k House No.StreetHamlet, Owner or Owners of Property .... Gerard, P. G o e,h r i n.g e r . _ . . County Tax Map No. 1000 Section ).0 6 , , , Block ..6 ............ Lot . , . 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 $ a, ............. . Construction on above described building and�t meets a ap a co sand regulations. Applicant.... ..................... G e r a'r d' P'.' ' G o e h'r f ►i g e' Rev. 10-10-78 q, -Lt co 15 5 o 1 CONSENT TO INSPECTION Gerard P. Goehringer the undersigned, Owner(s)Name(s) do(es) hereby state: That the undersigned (is) (are) the owner. (s) of the premises in the Town of Southold located at North Drive, Mattituck, New York J. which is shown and designated on the Suffolk County tax map as District 1000, Section 106 , Block 6 , Lot 16.1 & 17. That the undersigned (has) (have) filed, 'or caused to be filed, an applica- tion in the Southold Town Building Inspectors Office for the following: Certificate of Occupancy That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: 12/16/86 (signature) Gerard P. Goehringer Iry(print (signatu e) (print name)