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Home My WebLink AboutZ-9267FORM NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT, Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. . 79?6.7..... Date ..... QGto1?er.. U . . . . . . . . . . 1 19.7A THIS CERTIFIES that the building located at .2.O.Q.Di'.er,Patll(t .$d.,)go�x Map No ............. Block No........... Lot No............................ . . REQUIREMENTS FOR ONE FAMILY DWELLING BUILT PRIOR TO conforms substantially to the ---h —06emiefflm 51 111- LffjLjLjM4)fjhW CERTIFICATE OF OCCUPANCY dated .... April. 23........ 19.5? pursuant to which No.. Z9267. dated .... QctQber , .25......, 1978., 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. no. ............................... The certificate is issued to ............ Hienry..F, . PPI -4 ............................ ( owner, of the aforesaid building. Suffolk County Department of Health Approval .......... N/R ...................... UNDERWRITERS CERTIFICATE No . .................. X/.R ...................... HOUSE NUMBER .. 200 . . . . . • . . Street ........... Deer. Path .(Pvt. ,Rd. )....... . Mack, .New .York ....... Building Inspector Housing Code Inspection October 24, 1978 200 Deer Path - (Pvt. Rd.) R-1 Mattituck, N.Y. Tax Roll: Henry E. Pohl occupied: owner Upon receipt of an application for a Pre -Existing Certificate of Occupancy I made an inspection of the dwelling at the above captioned premises. I was admitted to building by Mr. Pohl who accompanied me during this inspection that began at approximately 12:05 P.M. This building is a one story wood framed structure constructed on a cement block foundation. Ground floor contains a living room, two bedrooms, full bathroom, kitchen and dining room, Heat is furnished to all rooms from an oil fired forced warm air furnace located in full cellar. Hot- water is furnished to all plumbing fixtures within dwelling from an electric hotwater heater. Access to cellar is by stairway located in attached one car garage. I found no violations of the Housing Code, Chapter 52, Code of the Town of Southold, N.Y. Inspection completed at approximately 12:20 P.M. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 2 A. This application must be filled in typewriter OR ink, and submitted in t*40iesfe 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 October 18 1978 Date............................a................. New Building .................... Old or Pre-existing Building .........A............... Vacant Land ............................ Xr Location Of Propert .... r t tt $u�-.� kv.et..44ut tgal4 ..9�'... �!M11ar.. fir Owner Or Owners Of Property ........................................... A4i1=_�..w'�............................. Subdivision................................................................Lot No............. Block No............. House No.4-.O....... 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 $ .....e ...................... Construction on above described building and perri7it�meets all applic ode and regul tions. Applicant............`.`../.......=�1, ............................... ................. Sworn to before me this �Q. day of ......................... ....1 / T (stamp or seal) Notary PubCo n �WIBLOLA NOTARY PUBLICIC,, of 5+a+e of Now York a (� 7 r/ IIII"kA. ren^�� No. 52-5712500 ( O R TARY y_.�, Qualified in Suffolk Couon� �� p Term Expires March 30, Igpv " /� G 7 P.u�n yW7 STATE OF NEW YORK 88.: COUNTY OF SUFFOLK HENRY E. POHL, being duly sworn, deposes and sayss That I reside at Deer Path Road, Mattituck, New York and I am the owner of the premises located 129.50 feet south- east of Miller Right -of Way in Mattituck since June 7, 1957. That the said premises had been owned by William H. Wertenberg and Evelyn Wertenberg, his wife, for 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. Henry E. oh Sworn to before me this 18th day of October 1978. WILLIAM CLARK NOTARY PUBLIC, Sfefe of Now York No. 52-5712500 Qualified in SuffaK Co-.:nfy_ Term Expires March 30, 19110 forme, -1Y Chas. Schi.�d/ems M/LL,e,q �. _ R/GNT OF W,4 S.B5�30'pa- .i w x p i 4 erl yt; 1 r f �bo �p nDv Op` 000 7°30 �a a ik� T/TLE NO. 7B-.5Z-ZZO63 u 0 Sia 1 V\ N N W j�1 O 00 .k �1Y` 030 o er�Y 5 62 form -4Ljer SURVEY FOR THOMAS AIA NSON rlow of j? AT Md TT/TUCK TOWN OF %504/T1404.4;P SUFFOLK COUNTY, NEW YORK * UNAUTHORIZED At TERATIf,N OR ADDITION T^_ THt$ SURVEY IS 4 VIOLATION OF SE:a ION 7209 C` THE NEW YORK STATE EDUCATION LAW *COPIES OF THIS SURVEY NOT BEARtNC THF LAND SURVFYOR'S INKED SEAL OR F MBCSSt.. SFA;, SHALL NOT BE CONSIDERED TO BE A VALID !RUE CPY. N GUARANTEES IVDICATED HEREON SHALL RUN CNITC THE PERSON FOR WHOM THE SURVEY IS PRFPARED, AND ON HIS BEHALF TO INC TITLE COMPANY, GOVERN- MENTAL AGENCY AND LENDING INSTITUTION ISTED HEREON,AND TC THF ASS;GNEES OF THE LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SURSEVUENT OWNERS. M DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINLS OR FOR THF ERECTION OF FENCES. DCT. a, 1978 DATE ' SEPT 25,/978 SCALE %"= SD' NO 76-,5-97 GCM 4G/JTfl O To r CENE/N/CGL B4N c i Gl.SL/FB T/TLE SSP E/�t] c0. lee YOUNG & YOUNG PRD W �G 09` C ( 2 C I t 40 a 893 JfO v0� 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK ALDEN W. YOUNG,PROFESSIONAL ENGINEER - AND LAND SURVEYOR N.Y.S.LICENSE NO.12843 HOWARD W. YOUNG, LAND SURVEYOR 1 41 N.Y.S. LICENSE NO 45893