HomeMy WebLinkAboutZ-22104No Z-22104
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
Date JANUARY 13, 1993
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 2215 MINNEHAHA BLVD. SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 87 Block 3 Lot 56
Subdivision
Filed Map No
Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-22104 dated JANUARY 13, 1993
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING
The certificate is issued to WILLARD K. VANDERBECK, JR.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
-.0 9�1 /�'�
/,,�builaing Inspector
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION- 2215 MINNEHAHA BLVD. SOUTHOLD, N.Y.
number 6 street municipality
SUBDIVISION MAP NO. LOT (s)
NAME OF OWNER (s) WILLARD K. VANDERBECK, JR.
OCCUPANCY A-1 RES.
(type)
OWNER
tenant.
ADMITTED BY: FELICE VANDERBECK ArrnMPANTRn RV- SAME
KEY AVAILABLE
SOURCE OF REQUEST:
SUFF. CO. TAX MAP NO. 87-3-56
RENSSELEAR G. TERRY, ATTY DATE: JAN
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES ONE
FOUNDATION CEMENT BLOCK CELLAR NONE
TOTAL ROOMS: IST FLR. 6 2ND FLR. - - 3RD FLR.
BATHROOM (s) 2 FULL BATHS TOILET ROOM (s)
PORCH TYPE DECK, TYPE
BREEZEWAY FIREPLACE NONE
DOMESTIC HOTWATER YES TYPE HEATER ELECTRIC
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.
SWIMMING POOL
OTHER:
NONE
7, 1993
# E%ITS 3
CRAWL SPACE
UTILITY ROOM ATTACHED TO REAR OF
HOUSE
PATIO, TYPE
GARAGE 1 CAR
AIRCONDITIONING
STORAGE, TYPE CONST.
GUEST, TYPE CONST.
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION 6 BUILDING CODE
REMARKS: BP #35062 -CO Z-2895 ADD, BP #4190Z -CO Z-5542 ADD.
INSPECTED BY: l`" ;.� _ DATE ON INSPECTION JAN. 12, 1993
GARYJ,�'/FISfi TIME START 10:25 END 10:45
Form No. 6
TOWN OF SOUTHOLD 4r
BUILDING DEPARTMENT
TOWN HALL JM- 7
765-1802
t
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ....J? .nary. 7 s . 19.9.3 ...................
New Construction........... Old Or Pre-existing Building.........? ......
Location of Property. NQi;ph side of Minnehaha,Blvd,.Southold,.N. Y. 11971 .
House No. Street Hamlet
Onwer or Owners of Property .... W ILLARD, K;,VANDERBE CK, JR :. ..... ............. ......
County Tax Map No 1000, Section....... Qg?...Block.....03 ........Lot...056 ...............
Subdivision.... .................. .Filed Map ............ Lot .... ....... ...........
No. 3506 6/6/67
Permit No..LJQ:..419A ....Date Of Permit. 2/?4/69, , , , , ,Applicant WILLARD.K. VANDERBECK ...
Health Dept. Approval..........................Underwriters Approval.........................
Planning Board Approval ........................
Request for: Temporary Certificate........... Final Certicate..X .^......
Fee Submitted: $.IOD...QQ....................Pi,�,�y
C y s_5 orb a'„i .....� .Y,;.
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CUNSrNT t
TO
I\i-3CC"i ION ) `
Terry, Jr•, as Attorney for y�`y
Rensselaer RG.K VP;NDERBECK, JR.
WILLA , thr unc2crsir,n0d.
uwnerts) Namctc;)
do(es) hereby state:
That the undersigned (is) (xic0the owner(::) of the premise:; in the Tovrn
of Southold located at 'Laughing Water, Southold
xhich is :.;hown and dcsirn,ated on the Suf;'o1
County tax map as District 1000, Section 87 Block 3 Lot 56
That the undersigned (has) kbomi filed, or caused to be filed. an applica-
tion is the Southold Totcn L'uilding Inspector's Office for the follo:c-is:c:
Certificate of occupancy (Pre-existing dwelli
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, including
any and all buildings located thereon, to conduct such inspections as they may
deem necessary with respect to the aforesaid application, inc'.::diny insp^_ctiors
to determine that said premises comely With all of the laws, or din:^ccs, ..-ales
and regulations of the Town cf Southold.
The undersigned, in consenting to such inspections, do(es) so with the
kno-. ledge and understanding that any information obtained in the conduct of
such inspections may be used as evidence in subsequent prosecutions for vio-
lations of the laves, ordinances, rules or regulations of the Town of Southold,
Dated: January 7, 1993
lsignatu �,s-J� K• d'
Rensselaer G. Terry, Jr.
as Attor�ieyltf rIIWILLARD K. VANDERBECK, JR.
signature:)
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