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Home My WebLink AboutZ-11912TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NEW YORK CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the / X/ Land Building(s) Use(s) No. Z11912 September 9, 1983 located at 650 Bay Avenue Mattituck S Street Hamlet shown on County tax map as District 1000, Section 143 , Block 03 Lot 012 , does!,not%conform to the present Building Zone Code of the Town of Southold for the following reasons: the orooerty has insufficient land area. On the basis of information presented to the Building Inspector's Office, it has been determined that the above nonconforming /X/ Land /_/ 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: a private one -family dwelling and accessory garage. The Certificate is issued to EDNA F. JACKSON (owner, 1,ess-ee-ort=a1Tt1 of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. no record no record - 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. C r Q.C. !/�_ _—' Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 DUPLICATE 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 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 installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. S. 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 August 29, 1983 Date................................................ New Building ................ Addition ................ Old or Pre-existing Building t .... X....... Vacant Land .............. Lotion Of . (06-0rty West side of Bay Avenue, Mattituck, New York .................................................................................................................................... Owner Or Owners Of Property . EDNA „F,;...JACKSON.................................................................................................. Subdivision................................................................Lot No............. Block No............. House No............. Permit No ..................... Date Of Permit ....................Applicant.................................................................. HealthDept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $..15. 00 .............. � � Ka Construction on above described building and permit meets all applicable codes and regulations. ✓9[ f *See attached P Affidavit. Applicant M5KA:"F .7AC r. ....................................................... Sworn to before me this By Ra and Nine, Attorney -in -Fact Cfdi'( 3ll 1........ day of ......... Augus.t.,...19$3...... 6' / 4 I ` (stamp or seal) ��I . Suffolk C.l1Js r- Z Notary Public ........ .. County ELLEN t,7 raotwV Public. Stztc! c-' No. 4688634 Bul%s Commission Expires tAJrc 11,11._,..1'. i y4 e�� e �t Q a m 1\ N 5}e'nhDrd 33581 200 J m EYe Y° 9 a DRI rIY or nD'V 44 353 G_ 33,10 E m .'CYC851.64 V� 1 S IT _ 249.53 F O Z \ N 0 a pj0„� nos 510e5 M ti 9110 ` AnnD Or fDrmerlY 19.92 noW .`y \ REVISIONS YOUNG 3 YOUNG 600 OSTRANDER AVENUE. RIVERHEAD, NEW YORK S YD[37 20 •LDEN W. YOUNG HOWARD W. YOUNG IX[[w • L•XO [V [V [YOP • w. N. \ IT , .[ . ,,..r �....,�e SURVEY FOR: DALE D. MOYER 8 STACEY L. WAGNER M F S`� o Hp s_ e[ . 1-1. -U[ c>o., [ AT MA7T1T DCK I GUAR4N E Ito usu,ETIT FC i� r NOTE: I. ■a MONUMENT FOUND - TOWN OF woa EPr co iA�. [ R 2. ARE A=20, 168 S.F ” SOUTHOLD 3, SUFF CO.TA%MAP DIST. 1000 SECT. I43 ELK 03 LOT012 %� _ -- SUFFOLK CO.. N.Y. �.1,.11-1— .[.e SCALE.1.. =30 . I DATE- AUG. 16. 1983 N TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT FORMER OWNER ' N Sty i hr-o7 E ACR. S�., pp SND Q . x' C.t kG., W SG TYPE OF BUILDING r-- -y' SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS X000 ci'Q Q1z3 QO D 3 7 AGE ! BUILDING CONDITION i NEW NORMAL BELOW ABOVE ~–FARM Tillable Y44 Woodland Meadowland Meadowland Acre i Value Per Acre Value FRONTAGE ONWATER — FRONTAGE ON ROAD ~ i - a- 0— DEPTH House Plot i I BULKHEAD Total j i i DOCK 1 STATE OF NEW YORK) r ss.: j COUNTY OF SUFFOLK) �i EDNA F. JACKSON, residing at San Simeon By The Sound Nursing Hare, Greenport, New York, being duly sworn, deposes and says: 1. That she is the owner of the premises on the west side of Bay Avenue, Mattituck, New York, which is being conveyed to DALE D. MOYER and STACEY L. WAGNER-MYER (Suffolk County Tax Map No. 1000-143-03-012). 2. That there is a 2 story frame house and a frame garage on said premises. 3. That the residence was built prior to the turn of the century, and the garage was built in the 1930 's. 4. That no improvements or changes have been made in the structures since 1956. EDNA By Raym , Attorney -in -Fact Sworn to before me this day of August, 1983 Notary Public U i2 � NSk� ELLEN b+l. Notary Public, State of New York No. 4688534 - Suffolk County Commission Euparo� t'Jjrch 30, 1