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Home My WebLink AboutZ-4612No. Z4612...... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date ........... Apri3, .. i e...... , 19.V2. THIS CERTIFIES that the building located at .Pecoae • Bay • P2.sd ........ Street Map No. . X= ..... Block No. ... ZZ .... Lot No. ,=.... LKV"l.. jjry4,........... conforms substantially to the L t f • Cade ri®r to6i ifUatQ, Of Oaeup . p .... .. ♦prij,.... , 19. 57 pursuant to which I il dated . Apr1L ....... 1a....... 19!� ., 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 ...Private - one - family. dvsll-Ing..................................... The certificate is issued to i:exq Paris- ' ' ' 'per*Ti ' ' I I I I . . . . • • . ( owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Pre: .*Xi1Ktivg ................... UNDERWRITERS CERTIFICATE No ..... pt9o.039i3ting............................... HOUSE NUMBER... ...... Street..drAgt. P-Ra4ll-ie..Bey. 81Vd.... Laur*U- Dist. I1 ................................................................................. E tiros to h*vAjz codes .... eP !< ......................... Building Inspector If FORM NO. a TOWN: OF SOUTHOLD Building Deportment 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 triplicate 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. Date ..April 17. 1972 ............................. New Building .................... Old or Pre-existing Building .......x................... Vacant Land ............................ Location Of Property ...... .................................................. Owner Or Owners Of Property ... S? M.&..Foric.a??id.. ................................. 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 ties ............................................................................. Fee Submitted $.$..5.•.9lp ....................... Construction on above described building an mit all app icable codes and regulations Applicant .....1.:..y :............ .. ... c"'......... ..1J.C�% Sworn to before me this y . .' 1972 ............. (stamp or sea[) Z:n .. da of ......... .. Notary Public ......... ........... ... ... C my MiLLIRM J.'C:.RRK ijSjW public, State of NeW VN14 No. 30.5712500 Quaiioed in Suffok County Term Expiresfr?arrh 30, 1 I ) r P ECO N ►G 4�AY• Q tt 111 u O 0 � s..0 ,.•.r t. c•,..c Oi K1 5 <�)7-O4 ty N. tit, IS Mu t,4aH<r� MA\p c�- t_ At-ju ' '(( tw �y 1 �.. J✓G C) AOR Ar I TU C_� .w.Ci`fll-. �,:!• :,J�_L1Tr•J?_i,J r`v .�`r. +.�rG �:: ._ i =i� '.�•�H ! State of New York) ) SS: County of Suffolk) John J. Paris, being duly sworn, deposers and says: That I reside at 10420 Peconic Bay Boulevard, Mattituck, New York, and I am one of the named owners of the said premises since August 26, 1963. That the said premises have been occupied and used solely as a One -family dwelling since 1963 by myself and my wife Kathryn Paris. The former owners of the said promises, John 0. Roberts and Mary R. Roberts also used and occupied the premises as a one -family dwelling. i That the building on the said premises have been and are in good condition. ,F John J. Paris Sworn to before me this 17th day of April 1972. WIL4 HM S. CwFRK Yat' public, State of New NG. 30.5712500 Quail,edires pQaSUjfreh.�Unty 97 / Term t� FORM NO. 6 TOWN: OF SOUTHOLD Building Deportment 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 triplicate 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. 10960 Date ..aril. 17..197�................. New Building .................. Old or Pre-existing Building ....:..Z................... Vacant Land ............................ Location Of Property ....1A 2.0. . 0.Paacmla.3W.-Mud.-Xattktuak,..N.3.................................................... Owner Or Owners Of Property ................................. 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 Certificate3$tibg uee Fee Submitted $ A ..5..00 ....................... Construction on above described building a ermit salla cable codes and regulations. y , c Applicant ...... ............ ........ ..a`.:...........� .....,.�! Sworn to before me this rf ..17th..... day of .......PrAlt.. x,972 ............... NotaryPub ' .:.. ..... ...... ..... I C unty HILL J. CLARK qty Pub , State of NOW 46fk No. 30.5712500 Term th Lxpires ma ci- county 9Er/ (stamp or seal)