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Home My WebLink AboutZ-5739FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y., Certificate Of Occupancy No. ?.57jig...... Date ...............Jan....94....; 19..74 THIS CERTIFIES that the building located at . ,? �! . ; :;� ,crop, -Road ........ Street Map No. .. xx........ Block No. ..xx...... Lot No. xxx .. C:U> Gr. hc�.gtle ..'? .' ......... . requirements for one family dwelling & housing code conforms substantially to the�� 1 fehi ate. Occupancy Autei t•be•fore•-Apr...��..., 19. 7. pursuant to which�r � 1 o.r��-.:73 � =>.. dated ......... J n ...1.4 ...... 19.74., , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pri.va ve..one,. f.aiz:L 17 .4"Ye.v.71�1,9".. and. three. Aec®s.5ory .Buildingq The certificate is issued to ..2'hqC1:? C:va AyslliborsirA. 6C. I;a.j.: a..... Owners......... . ( owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval. ..1 r•.e-r. . ex-lati g ................... . UNDERWRITERS CERTIFICATE No. .pre . existing .......................... HOUSE NUMBER .......5575... Street ....Oz: e; fan -1` aad ......................... ................................................................................ ......................... Building Inspector HOUSING CODE INSPECTION January 14, 1974 #5575 Oregon Road Mattituck, N. Y. Tax Roll: THEODORE MYSLIBORSKI & Wf. Occupied, owner. Upon request of the Southold Town Building Department, I made inspection of this two story framed dwelling and found the following violations of Chapter 52, Housing Code, Town of Southold. I was admitted to the west entrance by Mr. Mysliborski who accompanied me during inspection which began at approximately 10 A.M. The first floor rooms consist of kitchen, laundry room, full bathroom, living room and dining room. Heat is supplied to these rooms. There are three rooms on the east side of the building that are unheated, being used for utility and storage. The second floor consists of three bedrooms and one full bathroom, with heat furnished to each room. Cellar: Smoke stack connection at chimney not sealed. Sec. 52-54 A-1. Full supply lines unprotected on cellar floor. Sec. 52-15. Three accessory buildings in rear yard. Underground installation of wire supplying current to building on northeast corner - not of the underground type, - connection inside building (wires twisted) and taped, not in junction box. See 52-56 A-1. Inspection completed at approximately 10:50 A.M. espectfully bmitted, Edward Hinderman Building Inspector EH :mm 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..January„ 11,,,,1.974 ............. XX New Building ................ Addition ................ Old or Pre-existing Building ..X...... Vacant Land .............. Location Of Property ..N4§ .. at Mattituck .................................................................I........................... Owner Or Owners Of Property .... ThCOdO .o�....aIId...AnAa.. MviUIP.Qr.�iKi........................................... Subdivision................................................................Lot No............. Block No............. House No............. PermitNo ..................... Date Of Permit ....................Applicant.................................................................. Health Dept. Approval ............................................Labor Dept. Approval ................................................ Underwriters Approval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...... 5.00 .................. Construction on above described building d it meet all op ica a cod d r ulations. Applicant...................................................... ............... .... ..........•......... Charles W. Gatz, Esq. for Sworn to before me this Theodore and Anna Mysliborski .....LIP.... day of ....Js1xiW.at9Y.%... 1.9.74........ (stamp or seal) Notary Public ...........$t ff.Q ,k........ County ,✓ / RARVEY A. ARNO^E i- NOTARY 'PtJBLtC. State of New York �_ NoTe2rn Expi es March 30, I9`�(� STATE OF NEW YORK) ) ss: COUNTY OF SUFFOLK) THEODORE MYSLIBORSKI and ANNA MYSLIBORSKI, being duly sworn, depose and say: That they are over the age of twenty-one (21) years of age and reside at no number North Road, Cutchogue, Town of Southold, County of Suffolk and State of New York; That the premises in question were originally owned by the father of ANNA MYSLIBORSKI, namely, FRANK BIALECKI, who died October 5, 1970; That the deponents have resided in the dwelling on said premises for over twenty-five (25) years; That under the Last Will and Testament of FRANK BIALECKI, said ANNA MYSLIBORSKI received the said buildings and real property containing approximately forty-eight (48) acres; That as a result of an executor's deed from ANNA MYSLIBORSKI, as executrix of the Estate of FRANK BIALECKI, deceased, to THEODORE MYSLIBORSKI and ANNA MYSLIBORSKI, his wife, dated April 29, 1971, was recorded on May 3, 1971 in the office of the Suffolk County Clerk in Liber 6924 at page 28; That since they have resided in the dwelling for so many years, they are very familiar with same and the premises; That the property in question was never used for anything else except their residence and the acreage for farming purposes; CHARLES W. GATZ II ATTORNEY AT LAW continued on Page #2 RIVERHEAD. N. Y. Affidavit of Theodore Mysliborski and Anna Mysliborski Page #2 That the dwelling and accessory buildings are in good condition; That they are making this Affidavit knowing the Building Department of the Town of Southold will rely upon the statements made herein. A efore me this January, 1974. lic CHARLES W. GATZ NOTARY PUBLIC, State of New York }.No. 52-6472000 _ Suffolk County Commiaion E>mirli March 30, I9,7(� CHARLES W. GATZ ATTORNEY AT LAW RIVERHEAD. N. Y. THEODORE MYSLIBORSKI ANNA MYSLIBORS fI