HomeMy WebLinkAboutZ-23981FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCuuvANCY
No Z-23981
Date OCTOBER 24, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property. 1230 WEST C~EEK AVENUE cuTC~O~UE NY
House NO. Street Hamlet
County Tax Map No. 1000 Section 103 Block 13 Lot 10
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 E-23981 dated O~TOBER 24, 1995
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 A ONE FAMILY DWELLING WITH ACCESSORY GARAGE.
The certificate is issued to
THO~%S & GEKE~ WIU~U~%M
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTA~D INSPECTION REPORT.
Rev. 1/81
Ill[ l I,I) 1 i'l{; [)E I'AIt I'HE~4 1'
'l'O~tt OF ~OU'FHOLL)
IIOIJS ] tic COl)f: ! IqS PI~C'[' J O}l R E PO WI*
[,()CAT J()~:
1230 IqEST CREEK AV~,NUE
(m~mber & street~
CUTCHOGUE NY
[.o'r(s)
,*;UI½I)[VISI()N HAl) ri().
}IAHE OF ()~4t~l':R (:~) T]FIOTVI[AS T~ICKRAP[ &
(}CCUI'AHCY A-I ~S. O~R
Al}ti I TTEI) BY: ~A~ CO~RELL ACC(}HPAN I ED BY: ~A~ COTTRELL
KEY AVAII.ABI.~ ............................. ~iH~l.-'.~(~. ']'AX HAl' HO. 1000:~03-13=I~
SO}II(CI~ {iF III~{i~II':S'I': ~EKEE ~C~ I)ATE: 10/17/95
I)T~EI.I,I N(;:
'r~i'l~-6~ ~()~WrlO~C'['~O, ~ P~
TOTAl, III)OHS: IWI' I,'I,R. 4 2}ll) FI.l(. 2 3RI) Iq,l(.
UTII, ITY ROOH
PATIO CEHENT & SLATE
GAI{A(;E
BATIII~OOH (s) 2 'I'OiI.I~T I{O(}H (s)
POI(CII TYI'E ENCLOSED }lEST SIDE DI':CK, TYPE
IIRI': I,:ZE~4AY F I REI'I.ACI~ ORE
I)OHISST I C IIO'1 ~4A*I'I~I( __~E~ .... TYPE III:.ATI':It OFF BOILER A I I(CO}ll) I'l'l
'I'YI'I~ IIEAT OIL ~AllH A1 l( IIO'I~ATEI(
O'I'IIEI~:
ACCISSSORY STItlJC'I'IJRISS:
(;ARA(;15, 'I'YI'I~ O1" COHST. O~ CAR ~OOD F~ s'roIIAGE, TYPE
ST41HHI}IG I'OO1, , GIJISS'I', 'I'YPI~ CONS'I'.
(YI'IIE 1~:
¥1OI,ATICINS: CIIAPTEII. 65 }l.Y. STATE IINIFOIIH FIR[': PI{F, VEIJT1ON & IIUII,I)I}IG COI)E
I,OCAT 1 ()N DESCR1 I'TI O}l AWl' . SEC .
TOWN OF SOU?HOLD
BUILD[NC- DE?ARTHENT
TOWN HALL
765-{802
APPLICATION FOR CERTIVICATE UP OCCUPANCY
This application must be filled in by typewriter OR ink and submitted
inspector with the following: for new building or new use:
i. Final survey of property with accurate location of all buildings,
co the building
property Lines,
streets, and unusual natural or topographic features.
2. Pinai Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical instal!arian from Board of Fire Underwriters.
Sworn statement from plumber certifying ~hat the solder used in system contains
less than 2/I0 of lZ lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and instalia'tions, a certificate.of Code Compliance from architect or engineer.
responsible for the building.
6. Submit Planning Board Approval of completed site plsn requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings~and
"pre-existing" land uses: ~
l. Accurate survey of property showing ail 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 I,spector shall state the
reasons therefor in writing to the applicant.
Certificate of Occupancy - New dwelling $25.00, Additions
to dwelling $2~.O0,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00.
Additions to accessory building 525.00. Businesses $50.00.
2~ Certificate of Occupancy on Pre-existinR Buildi~m -
3. Copy of Certificate of Occupancy - $20.00
&. Updated Certificate of Occupancy - $50.00
5. Temporary Certificats of Occupancy - Residential $15.OO., Commercial $[5.00
Oa te ... .............................
Ne~ Construction ........... Old Or P~e-existing Building.
Location of Property.. .................. .~'~..c~.~ .............
~ouse No. Street Ha,ale t
9nwer or Owners of Property. ~.. t ~ ...............................................
]aunty 1'ax Map No lO00, Section .............. /;luck ................ Lot ......................
~ubdivision .................................... Filed H;~p ............ Lot ......................
:~erl,_t No ................ Dote Of Permit ................ ADp[ir:laC .............................
Health Dept. Approval .......................... Urlderwric~_r$ Approval ........................
'i~nning Board Apnrov;ll ........................
to,, Submitted:
Temporary Certificate ........... Fin;Ii Cetticate ...........
........................
CO~
IN.q PI~CTION
Ox:met(s) Name(s)
the undersigned,
do(es) herehy state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at_
d
, which is shown and designated on the Suffolk
County tax map as District 1000, Section {O 3 , Block t~ , Lot {t~
That the undersigned (has) {hage) filed, or caused robe filed, an applica-
tion in the Southold Totem Building Inspector's Office for the following: ~
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above deserlbed property, including
any and all buildings located thereon, to conduct such inspections as they may
deem necessary with respect to the aforesaid application, including inspections
to determine that said premises comply with all.of the laws, ordinances, rules
and regulations of ti~e Town of Southold.
The undersigned, in consenting to such inspections, do(es} so with the
knowledge and understanding that any information obtained In the conduct of
such inspections may be used as evidence in subsequent prosecutions rot vio-
lations of the laws, ordinances, rules o~' regulations of the Town of Southold.
Dated:
-(signature}
(print name)
(signature}
(print name)
0'00 ~
I