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Home My WebLink AboutZ-7628F~RM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'a Office Southold, N. Y. Certificnte Of Occupancy No. a.y?.~.c: ...... Date .............. Apr~]:.. 2.~..., 19 .~.7. - THIS CERTIFIES that the building located at . .Meda,~. Ave ................ Street Map No~l~o~d.. Block No ........... Lot No, .~.. ~tti.~uck...N ,~, .......... conforms substantially to the ... ~r. tifi~te .of. oecurency d~lt. before. A~r..~?-~, .... , 19. ~?. p~suant to wmc~~t~o, g7628. ·. dated ........ Apr[~ ... 29 ·., 197~.., was issued, ~d conforms to ~I of ~e requir~ ments of the applicable pro~sions of the law. The occupancy for which this ce~ificate is issued is . ~-~..-~ ...... . .Ch .... f~t:Ll~'.~,,,..1, ling ....................................... The certificate is issued to .. Pe.t~. Iioku!~: ...... ~,ma~ ............................ (owner, lessee or ten,t) of the aforesaid building. S~olk County Dep~tment of Health Approval ~e~..exts.tlng ..................... UNDERWRITERS CERTIFICATE No..~re~..e:i:;tl~g ............................ HOUSE NUMBER .... ~ 3-0 ...... Street .. I~)day..Z~ve ...... ~,-~ %ittiok ............ code Building Inspector FORM NO. 6 TOWN OF SOUTHOLD , BniJdJng Department Town Clerks Of(ice Southold0 N. ¥. 11971 APPLIGATION FOR GERTIFICATE 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: I. 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. 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 Date ...... "ApriL.2.7.~..l~.?.2 ...... New Building ................ Addition ................ Old or Pre-existing Building X Vacant Land Location Of Property S./..~.......M..e...d..a.~`9.....A...v..e..?.....1..2..1...~.....f..t/..~.....E./..~..f....~.~...X..e...s......L~...~...e.~....~..a...~..t~...i..~...u..C..k..~.....~..uf~zk Owner Or Owners Of Property .... ~.~'~;~..[Q[~w~l~[ ................................................................................... S .... Map of Tolle Wood , - 7~ none No none UDa~v,s,on ................................................................ t.or No ............. Block No ............. House ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate / Fee Submitted $ ..~.~Q.Q ......................... Construction on above described building and_permit mee_~all appljcabl_e codes and regulations. Applicant...~..~.../.~....'.~ .......................................... Sworn to before me this ...~.....'7. .... day of Notary Public ..... ../~.../7..~.. ~./..~....~.. ....... County CHARLES F. NOTARY PUBLIC, State o~ New 'fork ~ No. 30-5~326?50 HOUSING CODE INSPECTION January 27, 1977 9130 Meday Avenue Mattituck, N.Y. Sub. Div.: Tollewood, Lot 974 Tax Roil: Pete Kokulak Occupied: Thomas Libretto Upon receipt of a request for a Pre-existing Certificate of Occupancy from the First American Title Company, 210 Court Street, Riverhead, New York, I made an inspection of this one and one-half story wood-framed dwelling. I was admitted to building by Mrs. Libretto and began this inspection at approximately 2:15 P.M. The first floor consists of a living room, kitchen, full bathroom, and two bedrooms. The second floor has two bedrooms and a half bath. Heat is furnished to all rooms froms a gas fired, warm air furnace located in the full cellar of building's poured concrete foundation. The following violations of the Housing Code, Chapter 52, Town of Southold, New York, were found: Kitchen - gas cooking range, no shut off valve at unit, Article V, Section 52-52 B (2). Cellar - gas fired, warm air furnace, no shut off valve at un-~-~--, Article V, Section 52-52 B (2). There are no accessory structures on the premises. was completed at approximately 2:35 P.M. ~wPar/H i~d~ect f~ly~ubmitted ' Building Inspector Inspection EH:med