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Home My WebLink AboutZ-4679 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .46.79 . . Date . . . . . . . ..... .r3''Me..22. . . . . . . . ., 19. 72 THIS CERTIFIES that the building located at . E/S. Cox.Neck.Road. . . . . . Street Map No. . = . . . . . . . . Block No. . . .= . . . .Lot No. . eCI Ireme t f. or fa Z diVeI ' . b t conforms substantially to the N prior to 'A r� . 2 19.�7. pursuant,to whit C 'r �'e of occupancy p p 3 hXk i71+679. . dated . . . . . .June . . 22 . . . . . . .. 19. r12., 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. •fami:zy•dvell ng. . . . . . . SEF,.note:• exceptions. . . . . . . The certificate is issued to .Cha-l;eS. d: .Zaj• e• • • • •owner. • • • • • • • • • • • • • • • • • • • • • • (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -Pre. wexis••ting• • • • • • • • • • • • • • UNDERWRITERS CERTIFICATE,.No. ...-.,.I?rem_.e;xisting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER. .300. . . . .Street. -Cox- -Neck. Road. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Exceptionst ----- 1,.. N. Property line = fenced area &adjoining gargd. . . . . . ..,: encroachment Building Inspector / 2. '®n S. property line = paved driveway and garage overhang on adjoining lot w � 1 1 STATE OF NEW YORK ) :SS.. COUNTY OF SUFFOLK ) CHARLES J. ZAJIC, being duly sworn, deposes and says:; That I reside at 3040 Cox Neck Road, Mattituck, New York and I am one of the named owners of record of the said premises since July 22, 1950- That the said premises were improved witha one-family dwelling in 1951 and have been used and occupied solely as a one-family dwelling since that time by myself and my family. That the .building has been maintained in good condition since the time it was built. 'Charles J. Z�,is 1, Sworn to before me this 17th (ay of J e 1972 71 �"�a_.unw.; J. Cow ---- Public,State of moo No. 30-5712500 Qualified in Suffolk county .'Perm Expires March 30, 19 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 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. 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 ... .................... New Building .................... Old or Pre-existing Building .......X................... Vacant Land ............................ Location Of Property .39 4..4ax..Neek.-Road..Matt3#ack,..N,Y.,......................................................:......... Owner Or Owners Of Property .. arlee..J...&..AQx9tbyi.7zja.o.................................................................. 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 $ ....J.t.Y.Q......................... Construction on above described building and permit meetseall 7alicable codes and regulations. Applicant 1.�'�". . .. . ......... ....... ..... ...... .....,......................... ...................... .......... Sworn to before me this ....19Nh... day of ....i one....1972.................... (stamp or seal) q"(9 Z Notary Public ..Svffal.k................... County 6� rc;563.1 . r Xn►ceo :Gnz.� N, S 8` 3 a' t7" -- 471.0 r pd 1 - — fa cl DOCK / O (] PEED LtNbg LEVEL D 1, -10 M �' �_} 1 KK.Flo• oil ��STEPS • LJ L Lli Q ` 9� i SLACKT-op - __. -- --- — - RfY ; 3 0" W. vJ I s OF �! sulzVEYED F0[Z D & J 3 i T IIJ Ai E AT /10�UCATION ED ALTERATION OR ADDITION _ VEY IS A VIOLATION OF CUARAINTEED TQ T�4r-_ U,5, L1FE - ITLE .. g OF THE NEW YORK STATEy //y'� `,�� F Ti X 41 F'ti AW. 1N5UPANCE/CCU, AND TQ THE SQUTNOLD 1 V�'d N QF .S. nU_Ci4�U1-,).� IN.Y. HIS SURVEY MAP NOT BEARING SA`�INGS BANK WA AY ESHAU.N'7 BE CO ORDERED • ;SURVEYED • J11IWE 16 , iqii`�! L_E Q tr�5 0t ; I{ EES tr�CAT��N SNAIi tl 8 VA 1 V TU )` 0 I R O N 7 i C E QT ll1fTL TE?c WE'SON FOE VIFDOPA T19 SURM �- 'lStnkA'lW-Ai.D ON HiS ZEIiAU 10 99 • t LA d H L h.4 E N 7 F 0 U N D TrxE-co.,:-.ouly.eOvmQjBau A „'AW tt /+ �`('p / A �+.' ttww'G sm.- ajoN E.STLD A3 D L..I C-E iN S E 0 L 4 i`l D S U Mcm ry `��RE�:c ai1� G2EE-gPQZT ., NEW YOWK QO ADDITIONAL aculTLTdQp6 ca swJmQjww'L PIERS.