HomeMy WebLinkAboutZ-10472 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hatl
Southold, N.Y.
Certificate Of Occupancy
No... 2104.7.2....... Date A,pr.11. 27 198 ~ .
THIS CERTIFIES that the building .
Location of Property ...8280.. Gr.eat..P.econ.is.8ay..$l~.d.,......Mattituck~, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section ..t26.......Block J 1.........Lot ..~.9 .
Subdivision ...............................Filed Map No. ........Lot No. .
re irsme~t~fo~M a one family dwelling built prior to
conforms substantially to the A~iea~:on- g-I'ermitfieretofore-filed-i1[rthlsZ7fflCa'd'dteti"'
Cer 1 ts f c upancyZ10472
.......April . 23..... , 19 57 pursuant to wdmg Y~da. ^ .
dated ..April , 27, , , , , , , , , , , , , , , , , 1~ ,was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .
Private One-Family Dwelling with accessory ::tructurel2 CPr ;:e.rage)
The certificate is issued to ...Augustus .D.. KelaaY..aud, ,$~tp, ,It,, Knudsen , , , , , , , , , ,
(owner, le,~g4l.SPp3r1tL _ _ _ _ _
of the aforesaid building.
Suffolk County Department of Health Approval ~lR .
UNDERWRITERS CERTIFICATE NO....~illt . .
~4/ . Y . .
Building Inspector
Rw. t/at
$UILDITJG DEPARTT~IENT
TO~~.'T7 OF SGUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Locatiori 8280 Great Peconic Ba B1
number ~ street Municipality
Subdivision Map No. Lots}
Name of Ovm er(s) Augustus D. Kelsey and Ruth K. Knudsen
Occupancy R-1 Unoccupied
type ( owner-tenaa;t
Admitted by• self Accompanied by; self
Key available Joan Yetti Real EstSuffolk Co. Tax No. 126-11-19
Source of request Robert F. Hall Date April 16, 1981
D«.LIT1G
Type of construction wood 2
'stories
Foundation Cement Block CellarPartial Crawl space x
Total rooms, 1st. Fl 2nd. Fl 3rd. FI
Bathroom(s) 1 Toilet room(s) 2
Porch, typeLge.Glassed InDeck, type wood Patio, type
Breezeway Garage Utility room
Type Heat oil Fired '~Tarm Air Hotwater x
Fireplace(s) 1 No. Exits 3 Airconditioning
Domestic hotwater Yes Type heater Tankless
Other
ACCESSORY STRUCTURES;
tiara e t~
g ,ape const.2 Car_wood Storage, type coast. Wood
Swimming pool Guest, type coast.
Other
VIOLATIOPIS: Housing Code, Chapter 52
Location Description Art. Sec.
Kitchen Gas Stove no shut off
V 52-52-E6
Outside House needs painting III 2-31-B
Wood Stora e
Building Needs repairing badly III 52-30-A
Remarks: ~ ~
Inspected by:-~~ -w. ,/~q~i"1Gn,Late of Insp. April 22, '81
Cuhtis W. Horton Time 5tart3:00 end 3:30
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
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-
torwith 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, acertificate 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 peoperty 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 or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ...April. 9.,..1981 _ . .
Constructed
~g~~g .............Old or Pre-existing Building ...191,9...... IP~~~~[r}~ .
Peconic Ba Boulevard Mattituck
Location of Property
Nouse No. Street Hamlet
Owner or Owners of Property ,Augustus D. Kelsey and Ruth K. Knudsen
County Tax Map No. 1000 Section ....126....... Block .....11 Lot 19
Subdivision .................................Filed Map No. ..........Lot No. .
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval .....................:~j~
Request for Temporary Certificate .....................Final Certificate
Fee Submitted $ .5.00 ~3 1
Construction on above described building and per i meets all app 'cable codes and reg ti s. ~ ^
Applicant ! . ,VIL
August D. Kelsey
Rev. 10-10-78
STATE OF NE?d YORK )
ss,.
COUNTY OF ~dASSAU )
AUCUSTUS D. KELSEY, residing at 15 rti'ebster Street,
Westbury, Neva York, being duly sc•~orn deposes and says:
1. TF',AT deponent and l:is sister RUT'S KNUDSFN, are
the owners of Section 126, Block 11, Lot 19, which is located on
Peconic Bay Boulevard, ?'Zattituck., Diew York;
2. THAT deponent's father_ and mother, namely, Melva_lle
A. Kelsey and Irene L. Kelsey, purchased these premises ir. 1927,
and the premises have remained in the family since said date; ~
3. THAT the one family dwelling presently situate
on the premises was constructed in 1919;
4. THAT the said premises have been used as a sum>•rer
home by deponent and his family since 1927 and the structure has
always been maintained in a good, safe and sound condition; and
TF~AT deponent requests that the Building Department
of Southold issue a Certificate of Occupancy herein.
f~
U zLp TU D. KELSEY ~'i
f ~ i
i)
Sworn to before nne this
j ~ y day of April, 1981.
Ili I
Rp6£R7 F. HAIL
Notary Putslic, State of New Ytxk
No.30-6756376
Qualified in Nassau CountyQ~
Term Expires Mar,:h 30, 79
Ii
,I
~I