HomeMy WebLinkAboutZ-18028FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18028 Date MAY 15~ 1989
THIS CERTIFIES that the building ONE FAMILY DW~TJ.ING
Location of Property 375 PRIVATE ROAD #19
House No. Street
County Tax Map No. 1000 Section 54 Block 01 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the requirements for a private one-family
dwelling built prior to: APRIL 23~ 1957 pursuant to which
SOUTEOLD ~ N.Y.
Hamlet
CERTIFICATE OF OCC. Z-18028 dated MAY 15~ 1989
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 DWRI~.ING *
The certificate is issued to JOHN F. WITHERSPOON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HFJkLTE APPROVAL NO RECORD PRE-EXISTING
UNDERWRITERS CERTIFICATE NO. NO RECORD PRE-EXISTING
PLUMBERS CERTIFICATION DATED NO RECORD PRE-EXISTING
*PLEASE SEE ATTACHED INSPECTION REPORT
-' / Bui~ng'Inspec~or
Rev. 1/81
Loc~ ~t~
375
BUILDIi,[G DEP~tPJ[.~NT
TO','~I OF SOUTHOLD, N. Y.
HOUSIJG CODE Ii'iSFECTIO~'[ REPORT
Private Road
Southold, N.Y.
~51oer ~ szree~)
Subdivision
Map No.
~Piunzc~pa£iLy)
Lot(s) ....
,Nmme of Owner(s)
JOHN WITHERSPOON
Occupancy
ONE FAMILY DWELLING OWNER
~ typ e) ( owner- ~ enan~
. OWNER ...... ~: ~Ac~zompani~d by: OWNER
Key available
Suffolk Co. Tax ~o.
54-]-10
Source of request_
OWNER
Date
3/8/1989
D%~LLi~YG:
Type of construction FRAME
Fotmdation masonery(cement block) Cellar
Total rooms, 1st. F1 BASEMENT 2nd. F1
#stories 2
Part Crawl space --
5 3rd. FI --
Bathroom(s) I Toilet room(s) --
Porch, t~ .... Deck, type. over cellar Patio, type
Breezeway -- Garage 5 Utility room --
Type Heat OIL Warm Air -- Hotwater Steam
Fireplace(s) ] No. ~its 2 Airconditioning
Domestic hotwater yes Type heat'er OIL
Other partial basement
ACCESSORY STRUCTURES:
Garage, type const.
Swim.ming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: CHAPTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
Location
Descriotion
Art. t Sec.
Remarks:
Tho~s J~Fisher;
..% >~j~.~:.'..~ ~:~..?~'.- .-. ...~ , .
Building Permit f/~7965-Z for a~dition under construction
Date of Insp. 4/~4/89
· Time start 3:~3 pmend 4:00 pm
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SODTHOLD, NEW YORK
765 - 1802
11971
NEW CONSTRUCTION
Location
County Tax Map No. 1000 Section
Subdivision .......................
APPLICATION FOR CERTIFICATE OF OCCUPANCY
~ ~.~ "~'"'1
DATE .~./2 4' '"' '~ .....
..... '..OLD OR PRE-EXISTING BUILDING .... ~.VACANT LAND ........
of Proper£y ............................ 2 . .......
HOUSE HO. STREET HAMLET
~. .. Lot .....
.¢. J.. ~ioc~ ....
Filed Hap ........ Lot ..........
Permit
Health Dept. Approval ..................
Planning Board Approval ................
Request for Temporary Certificate .......
No ........... Date of Permit .......... Applicant ...................
APPLICANt.
Underwriters Approval ..............
Final Certificate ................
rev. 10/]4/88
CONSENT
TO
INSPECTION
O%~er(s) Name(~)
do(es) hereby state:
· the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
which is shot~ and desi~nated on the Suffolk
County tax map as District 1000, Section~, Block O/ , Lot ~10
That the undersigned (has) (ha~e) filed, or caused [o be filed, an applica-
tion in the Southold To~ Buildln~ Inspector's Office fo~ 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 to the aforesaid 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 ~'[o-
lations of the laws, ordinances· rules or regulations of the Town of Southold.
I
Dated: ... y%%_ ~ ~/~.4.~*
~' / (signature)
n~ name)
(signature)
(print name)