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Home My WebLink AboutZ-9982FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy .......... Date .... .J..1~. ?..'1.7.,. ................... 19 gO. THIS CERTIFIES that the building ................................................ Location of Property ,,, ? ,07,~,,, ,S,~,g,s, ,b?,e, .P:o..~.d., ................ ,lVI,~:~, ~, ,5_. ,-~,c,l,~,(~,~s, ,~, p,2,d,_e Sigsb~ House No. Street Ham/et County Tax Map No. 1000 Section .... ']..~.~. .... Block . ~ ............. Lot.. ~ ............. Subdivision. ~'C~. ~.~k. P~.Q~ ............. Fried Map No.. E~01...Lot No... 83 ......... requirements for a one-f~mi~l~d%~l~ng.buAftt joy,or to conforms sUbstantially to the Application- for--Building-P, orm~l~g~o~r.-~uee In t1'1i8.- OttlC~ rrnIP~t_ certificate of Occuoancy .... .A.p.r..i.1..?.~ ....... ,19 .5.7. pursuant to w-l~dh-l~ffilai'n-g-Pel~i! No;- dated ..... .ff..m3 .e..1.7. .............. 19..8.0, was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.~..~¥.a.~.c ·, ~?.n~..~..Lz.y., .~..e.z.~..Ln~ ....................................................... The certificate is issued to .... E,~, ,~,h?,~, .M.~.d.s. ?.n ........................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ .N/.R. .............................. UNDERWRITERS CERTIFICATE NO ................ .~/.~. .............................. Rev 4/79 -:~:~-' -- TO~'Eq OF SOUTHOLD, N. Y. .-i .... - HOUSING CODE INSPECTION REPORT ::' Location 1055 Sigsbee Road, .~. Subdivision Matt Park P~p. "-: .... ~e of O%~er(s)_' EST~ ~S~ Mattituck ~I?unicipality~ Map No.~ 801 Lot(s) 83 Occupancy ~-1 ' (type) 'Ad'mitred ~Y:~' Self Source of r'e~ues, t~" William J. Clark (o~,.naer-t Chant) · Accompanied ~Y:. Sel'f 'Suffolk Co, Tax No. 144-2-3 '-' "' Date June 11, 1980 Type ~f cons~Tuction~ .'Wc~'d Fnam~d- Foundat~0n Cb'ment Block 'Tot~l rooms, 1st. F~ Bathroom(s)_ 'One -- ,~storie~' · Cellar~ PartialCrawl spac~ 2nd. F~ 3rd''F1 Toilet room(s)~ Forch,.tYPe_ ' ~)eck, type_ ~reezeway_ - ' Garage~ Type Heat. C'enteral,Gas '~farm' Air X Fireplace(s)_ ..~o. Exits_ Two Domestic hotwater Other Patio, type. Utility room Ho-~qater~ Aircond~tioning. Type heater~ G~_s ..... ACCESSORY STRUCTURES: NONE Ga?age,. type const.. Swimming pool_ Other. Storage, type con'st. Guest, typ~ 'const. VIOLATIONS: Housing Code, Chapter 52 ' Location .'- Description Art- Sec. ,, Kitchen- No Shu~ .~ff-,-G~s Stove V 52-52~E~! inSpect:d by:_ ~ Date of Insp.June 17, 1980 · / w ~ ' 15 end~, 10:30 Curtis Horton Tim~ star~_ 10: _ 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. 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 J.9..8...o. ................ New Building ................ Addition ................ Old or Pre-existing Building ..... ~ ........ Vacant Land .............. Location Of Property ...?...~.~...~..~.~...~..b.~e...e.....~..~...~.~.?....~...~.~.~.~..~.?.~...f.~..~.~...~.J-..~.e....~..~..~.'.~.~.~ .............. Owner Or Owners Of Property ...~.~..t...~.}..e....9.~....~..~...~..h...e..~.....~...~..~..~...e..~..~...~.e..~...e..~...~..e..~.. ................................... 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 $ .......... ~..:..O..O. ................ /:Constructioa°on above described building and permit meets all applicable codes and regulations. /hZ/warn to before me this ~:~/d~.~./~ .~ Deceased ..... .'].~l.~..b:.. day of ...~.g:.~...e....J...9..8...O. ................... // (stamp or seal) Notary Public ..~.L.~.../~.~...C..-./..~. .............. County ROBERT J. 9. SHAW ~OTARY PUBLIC, State of New Yol~ No. 52-894!~0C,0 C~galifier~ i~ SLJffc'!k ,~,Oq~ty ~ STATE O~ ~EW ¥O~[ ) )~.: COU~TY O~ SUffOLK ) WILLIAM J. CLARK, being duly sworn, deposes and says: That I am the attorney for the Estate of Esther Madsen, ! Deceased, the o~mer of record of the premises kno~ as 1055 Sigsbee Road, Mattituck. Upon information and believe the said premises have been used $~d occupied as a one-family dwelling for the past 25 yea~s. That the building erected on the said premises is and has been in good condition and suitable for occupancy as a one-family dwelling. Sworn to before me this 11 th day of June 1980.