HomeMy WebLinkAboutZ-5872FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z..5$72..... Date ............ Apxil... 24...... 19.7?+.
THIS CERTIFIES that the building located at . J rause—liodd ............. Street
Map No. ..XX........ Block No. XX .......Lot No. XXX ... MAttl t=*.. :`'........
conforms substantially to they 'it u� n" code
built K Occupancy
dated ..bv3 �?r..,nr#l.3.., 19.?7. pursuant to which �� o.
Z5872
dated ........... 4PT-4 _ . 21+. , 19.7}+., , 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 PriYPAe . cine. f?-Pily. c Weli.ing.......................................
The certificate is issued to . Jul as .Q.. Phi lalps....Wmar.........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . r:re-..exiating...................
UNDERWRITERS CERTIFICATE No..nre-ef..istinf ..............................
HOUSE NUMBER ........ Street .. z*rause. .iio4d..........................
. , . ...0 � ............
Building Insp/ctor
HOUSING CODE INSPECTION
April 24, 1974
#550 Krause Rd. R-1
Mattituck, N. Y.
Tax Roll: Charles P. Phillips & Wf
Unoccupied
Upon request of the Southold Town Building Department,
I made inspection of this one family framed dwelling and
found no violations of Chapter 52, Housing Code, Town of
Southold.
I picked up key from the office of North Fork
Housing Guild, Inc., North Road, Mattituck, and began
inspection at approximately 10:45 A.M.
The dwelling consists of two bedrooms, kitchen,
living room, full bathroom and an enclosed breezeway
connecting a one car garage. Heat is supplied to all
rooms from an oil fired furnace located in full cellar.
Inspection completed at approximately 11:20 A.M.
and key was returned to Alan Derrick at real estate office.
EH: nun
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
c
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 .. April... 22.1... 1974...........1
New Building ................ Addition ................ Old or Pre-existing Building ..x .......... Vacant Land ..............
Location Of PropertySouthwest corner of Krause & Camp Mineola Roads
...................................................................................................................................).
Owner Or Owners Of Property Julia G. Phillips (CNS'
.......................................................................................-....................
Subdivision................................................................Lot No............. Block No............. House No.4. .....
Permit No ..................... Date Of Permit ....................Applicant..................................................................
Health Dept. Approval ............................................Labor Dept. Approval ................................................
Underwriters Approval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate . ior,.Preexi.sting Dwellin€
��–
Fee Submitted $�:...........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant.....................................................................................
Sworn to before me 's J�� �Y tS ) `�
1 - / q /L 7
dsefi......... day of . ............ .... /./.......T (stamp or seal) D� S��
�y �s c 0
Notary Public .Z ................. ........... ounty
W!LLiAM cLAxx /
Y?c'rARY PUALIC, State 9f New YorS_ 7( J
No. 52-5712500
Qualified in Suffolk C44unfy/•
,rrm Expires March 30, 197201
STATE OF NEW YORE
COUNTY OF SUFFOLK
Julia Phillips, being duly sown, deposes and says:
That I reside at Krause Road, Mattituck, New York
and I am the owner of the premises located at Krause Road
and Camp Mineola Road, Mattituck, New York since October
5, 1966.
That the said premises had been owned by William
H. Kraus,, many years prior thereto and had been used and
occupied as a one -family dwelling.
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 toPefore me
this ;2,2 ay of
April 1914 n
LA
MC`TARY PU'BLIC�Sf�fa of New Yori
No. 52-57(2500
Qualified in S..ifolk Couoly
TOM Expiros March 30, 147.._