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Home My WebLink AboutZ-22411FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22411 Date JUNE 21~ 1993 THIS CERTIFIES that the buildin~ Location of Property 3865 GRAND AVENUE House No. County Tax Map No. 1000 Section 107 Subdivision ONE FAMILY DWELLING MATTITUCKr N.Y. Street Hamlet Block 1 Lot 4.1 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-22411 dated JUNE 21~ 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 DW~rJ,ING * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DA'fED *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 THOMAS & ELIZABETH WILLIAMS LOCATION: BUILDING DEPARTI~NT TO~N OF SOUTIIOLD HOUSING CODE INSPECTION REPORT 3865 GRAND AVENUE HATTITUCK, N.Y. (number & street) SUBDIVISION 1~ HO. NA~E OF ONNER (s) THONAS & ELIZABETRWILLIA~S (municipality LOT (s) OCCUPANCY A-I RES° (type) Al)MI'n-aD BY: TIt~ WILLIAI~ KEY AVAILABLE SOURCE OF REQUEST: TItOI~AS WILLIAMS JR. (owner-tenant) ACCOMPANIED BY: SAI~ SI/FF. CO. TAX MAP NO. 1000-107-1-4.1 DATE: ~ 14, 199~-, DWELLING: TYFE OF CONSTRUCTION FOUNDATION TOTAL ROOHS: BATHROOM (s) PORCH TYPE BREEZEWAY DOMESTIC HOTWATER TYPE HEAT OIL OTHER: WOOD FRA[I~ ~ STORIES ON~ # EXITS T~O CI~ffiNT BLOCK CELLAR FULL CRAWL SPACE IST FLR. 4 2ND FLR. 3RD FLR. I FULL BATH TOILET ROOH (s) UTILITY ROOM FPONT COVERED DECK, TYPE PATIO, TYPE FIREPLACE GARAGE YliS TYPE HEATER PROPANE AIRCONDITIONING WARM AIR XX UOTWATER ACCESSORY STRUCTURES: GARAGE, TY~E OF CONST. S~IMMING POOL OTlfliR: NONE STORAGE, TIFE CONST. · GHEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. r SEC. DATE ON INSPECTION JUN~ 18, 1993 TIME START 9:15 ENIJ 9:35 INSPECTED BY: Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 1% 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-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 si~ned 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 ~.$190.00 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 ..~. ................ New Construction. ........... , Old Or Pre-existing !~ ~ ~BuiVin~' .......... . Location of Property....U ~.4 .~. ............ ~ i~.' ....... · . ....... 7,/.. c x.. House No. Street Hamlet Onwer or Owners of Proper .. , ......... ~ ............. County Tax Map No 1000, Section..~.0..~ ...... Block ~. ...... Lot ~.' / . . Subdivision .................................... Filed Map ............ Lot ...................... Permit No ............. ... Date Of Permit ............ . ... Applicant. ........................ .. .. Health Dcpt Approval Underwriters Approval ........... Planning Board Approval ............. ' ....... Request for: Temporary Certificate ........... Final Certicate ........... ................ Fee Submitted: $ ..... ~ ....... APPLICANT :7, ~[ z CONSENT TO INSPI~CTION O%{mer (s) Name(s) do(es) hereby state: · the undersigned, That the undersigned (is) (are) the owner(s) of the premises in the Town & · which is shown and designated on the Suffolk County tax map as District 1000, Section /(9-/ , Block { , Lot ~. / That the undersigned (has) (have) filed· or caused to be filed· an applica- tion in the Southold Town 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 described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect te the aferesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the 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 for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. (signature) (print name) (signature) (print name)