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Home My WebLink AboutZ-4978FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~.978 ....... Date .............. ,;-an .... t8 .... , 19'73' THIS CERTIFIES that the building located at .E/.S .Camp .Mineola..Road.. Street Map No...X~X ...... Block No...X'A~ ..... Lot No. XX~ -. · P,a. ttitu~k-...N o¥, ....... conforms substantially to the cod® dl~tt .bolo. re. itprll-'23'" 19 .FT- pursuant to which ~~~t°~o.~~.cy dated .......... ga,a...1.8 .... , 19.~'~., 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 . .Private..cmo. family..dveLling ...................................... The certificate is issued to . Audrey. Groboll ..... Owner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · p~'e.-exis~;tng ................... UNDERWRITERS CERTIFICATE No .... pr.e .existing ................................ ItOUSE NUMBER..2]0~ ...... Street...Ca~..PlIIleo]~.. Road .......................... Exception to housing eerier 1. section of railing missing steps to rear entry See 216b 2. S/W Bedroom has doors to flat roof-no railing -"-.2t6b ................ : G arage doox' broken & passage door broken Sec 30~ding Inspector several broken window glass See ~Olc &~02b accessory building needs repairs Sec 603b FORM NO. 8 TOWN OF SOUTHOLD Building Depar~ment Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 equal). 3. Approval of electrical installation from Board 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 ld~,~-"%,a~'i~d 'e ,'~;Li ~[ ' Date ...J..~.au.~.<~r...J,.ao...~9.Z3 ........ New Building .................... Old or Pre-existing Building ....X.. ...................... Vacant Land ............................ Location Of Property ..C.~mp...~;Lafi.~.],.e...~,~.~3.d,o..~.e.t;~;,iJ;~c~,..~...Y.a~ ....................................... Owner Or Owners Of Property .... .A...u...d.~.~....~.~.O.~..e...q ................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House 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 $ ~.^.0.0 ........................... Construction on above described building .and permit meets all applicob,~q codes and regulations. Applicant ~.. ' {~ /'~' ...~..."~.. ................................. ~ ........;.~ ......~ ................. , ......................... Sworn to betore me thts ~A~ ~~;= aE A~dr~,, .... /.Z ...... d.y ....... ............. , mp or,e.O Nota~ Public ..~... County ~ TA Suf~ol~ Counfy No. 52-5034900 Commission Expires March 30, ~O~M NO. S TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 equal). 3. Approval of electrical installation from Board 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 ' (~y%j ) ~f~r~ n r, 6.~) /~r~o ~¢L,~ ~ ~ Date ....... New Building .................... Old o.r Pre-existing Building .:.X ...................... Vacant Land ............................ Location Of Property ..Clll~.~l..~l~..~~t..JJl~..~a~.k ...................................... Owner Or Owners Of Property .... AII~IP~...~ ............ i ....................................... i ............................. Subdivision ................................................... i ............ Lot No ............. Block No. ' House 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 applicable coj~s and regulations. .............. ............ .............................. Sworn to before me this ~--- ~ ~ .... 6-~' ,., ...... o, .... ~ ~ N R~TA H. ALAEMO ~uffol~ Counfy No. 52-50~4000_. / ~ ~:' -- / ~mm'ission Expires March 30, 19.~ /u./. R.D. TUTHILL ~).24e AREA· 37, T?E $O. FT O. GGF ACRE OF' ' RIGHT . APpOLONIA , KiRCHGESSNER NOTE: · · MONUMENT SURVEY FOR ,'APPOLONIA KIRCHGESSNER MATTITUCK TOWN OF SOUTHOLO SUFFOLK COUNT¥~ N.Y. SCALE: 1"-50' ~JUNE 5, 196T LAND ,SURVEYOR - N.Y.S. LIC. NO. ROTEG RIVERHEAD, N.Y. In re Property on Camp Mineola Road AFFIDAVIT STATE OF NEW YORK ) : SS.: COUNTY OF SUFFOLK ) says: AUDREY PIERCE, being duly sworn, deposes and (1) Your deponent is the owner of certain property on Camp Mtneola Road as set forth on a survey dated June 5, 1967, annexed hereto and made s part hereof. Deponent acquired title from Appolonia Kirchgessner, who presently resides in Mattituck, Town of Southold, Suffolk County, New York~ by deed dated March 19~ 1969. Deponent took title together with her first husband, Peter Groben, who died subsequent to taking title to said property with deponent. Deponent remarried on November 3, 1972, to Charles Pierce and is now known as Audrey Pierce. (2) At the time deponent (then known ss Audrey Groben) and her first husband~ Peter Groben, took title to the subject premises, we were informed by our predecessor in title that our predecessor in title took title to the said premises on May 1, 1940, and that the said premises have been used and occupied as residential property and buildings thereupon existed all prior to April of 1957. AUDREY PIERCE Sworn to before me this f~day of January, 1973. -2-