HomeMy WebLinkAboutZ-8201FORM.NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
No. Z11584
Certificate Of Occupancy
Date April 5 1983
THIS CERTIFIES that the building ................ : ...............................
Location of Property 19375 Soundview Avenue Southold
/d~ ~ hal ....................... 's't ie~ i ............................
Harn/ot
County Tax Map No. 1000 Section . . 05.1 ....... Block .0..1 ........ Lot .... .0.2.0. .........
Subdivision X
............................... Filed Map No. X .Lot No. X
conforms substantially to the Application for Building Permit heretofore filed in this office dated
September 19 19T.5. . pursuant to which Building Permit No. 8201 Z
dated Se ptember 19 19 75, 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 .........
... 9ne-family dwelling*
The certificate is issued to IRENE MEISSNEST (also known as
.. Irene Miller)
(owner,.lessee. ec~e~) ......................
of the aforesaid building.
Suffolk County Department of Health Approval n/a
UNDERWRITERS CERTIFICATE NO. n / a
*This certificate is for the addition and the building built and
used prior to April 1957, as a one-family dwelling.
Building Inspector
Rev. 1/81
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 installa-
tions, 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 app icable.
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
topograph ic 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
;3. Copy of certificate of occupancy $1.00
$5.00
New Building ............. ,~_OId or Pre-existing Building(X). _.~.. = ZVacant Land '. ...........
LocationofProperty/C~7~ "~ ~V - t~
............. · ................ i
House No. Street
Hamlet
Owner or Owners of Property ....~J-..~'v~¢._..J~.~. ~ ~ ~ .V~.~.~-~.. ..........................
County Tax Map No. 1000Section ....~,..[ ........ Block ...... ~ ........ Lot....~-.~ .........
Subdivision
................................. Filed Map No ........... Lot No ........
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval .........................
Underwriters Approval ........................ Planning Board Approval .................. , .. ~
Request for Temporary Certificate ..................... Final Certificate ...~:,, ........... . .
an r ulations.
,.v.,o.,0.,, GARY ~LANNER 0L~N ESQ.'" ...... ~ .................
P. O. Box 38
Main Road
Mattituck, L. I., N.Y. !1952
AFFIDAVIT
Irene Miller, formerly known as
Irene Meissnest
STATE OF NEW YORK)
SS:
COUNTY OF QUEENS)
Irene Miller, formerly known as Irene Meissnet, being duly sworn,
deposes and states as follows:
That I am the owner of the house described on Suffolk County Tax May as
1000-51-1~0. That said house was constructed prior to the issuance of
Gertificate of Occupancy and has been used for many years and is
suitable for single residential purposes, in my opinion.
Irene Miller
3ARY FLANNER OLSEN
COUNSELLOR AT LAW
MATT}TUCK, NEW YORK
Sworn to before me this
day of February, 1983.
Notary Public