HomeMy WebLinkAboutZ-17030FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z17030
THIS CERTIFIES that the building . 9.n.e. . .f.a.m.i. 1. ¥..d.~.e.l. 3.kn.g, .2..gu..e.s.t. ,...1..s.c..u.d.i.o...
Location of Property Madeline Avenue Fishers Island, N.Y.
h3ds'e 3iE ....................... 's't/o3i ....................... h3t~/~i
County Tax Map No. 1000 Section . . . 6. ........ Block .... .7 .......... Lot .... .7 ............
Subdivision ............................... Filed Map No ......... Lot No ..............
Requirements for a private one-family dwelling built
conforms substantially to the
Certificate of Occupancy #
prior.to April 23, 1957 pursuant to whichx~[illl~il0gX~IX'~l~/~lll. Z17030
dated . J..u.n.e.. 2. .4.,. i ! 9. .8.8 ............. was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for wtfich this certificate is issued is .........
One main dwelling, 2 guest houses (summer occupancy only) and I Studio
~ ~'n'- fi ~ b'i'i fib ~'e'. ................................................................
The certificate is issued to LILY EMI~ET WEST
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval ... I21../.A ....................................
UNDERWRITERS CERTIFICATE NO. Iq/A
PLUMBERS CERTIFICATION DATED:
N/A
SEE INSPECTION REPORT
Building Inspector
Rev. 1181
Location
Subdivision
Name of Owner(s)
BUILDING DEPART~NT
T0%'~ OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
MADELINE AVENUE, FISHERS ISLAND
(num0er & street}
Man No.
(Municipality)
ot(s)
LILY EMMET WEST
Occupancy R-1
(type)
A~mitted by:
Key available
Source of request
Bagley Reid
[owner-tenanZ)
Accompanied by:
lO00-
Suffolk Co. Tax N0.6-7-7
Date May 4,
1988
D~,,~LLING:
Typo of construction Wood framed
Foundation Cement Cellar
Total rooms, 1st. F1 3 2nd. Fl.
#stories
full Crawl space
4 3rd. F1
Bathroom(s)
Porch, type closed in
Breezeway
Type Heat oil
Fireplace(s)
Domestic hotwater Yes
Other
I
Deck, type
Garage
Warm Air
No. ~cits
Type heater
Toilet room(s)
Patio, typ~
Utility room
~x steam
3 Airconditionin~
Electric
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Three (3)
Storage, type const.
Guest, type const.
VIOLATIONS
Location
Studio
Guest Hous
Guest Hous
Housing Code, Chapter 45 N.Y. Stat¢~niform~Fire Prevention
& Buz±~ing
I Art. I Sec.
Description
story-2 rooms- ! exit-non habitable
studio
exit-no
exit-no
I story-2 rooms-1 bathr0om-I
heat-summer use only
1 story-2,,.rooms-I bathroom-]
heat-summer use only.
Remarks: No violations-Ch 45 were found
Inspected by~~Date of Insp. 4-25-88
c. Dixon -Time start ]:30 end2:30
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted i~ to the Building Inspec-
tor 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 disposel-(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 installa-
tions, 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 informa-
tion required to prepare a certificate.
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property ................ . .~..~ .',~.'. ,~.~.,...'~'~-.. ........... . .~.~.~ ,/~/~
House No. Street Hamlet~
Owner or Owners of Property ........................................................
County Tax Map No. 1000 Section ........ ~. ..... Block ..... .~.. ....... Lot .... /. ..........
Subdivision ....................... : ......... Filed Map No ......... . .L~.,ot No ..............
........... Date of Permit .......... Applicant...~.~..~...~-~../~.'. ..............
Permit No
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ . .~..~...~. .....................
Construction on above described building and ~mitmeets,e~applicable codes and regulations.
Applicant...(~..~.~~¢'-~X/);~I~ ..............................
Rev, 10-10-78