HomeMy WebLinkAboutZ-23379FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRM EXISTING
No Z-23379 Date NOVEMBER 30, 1994
THIS CERTIFIES that the buildin~ ONE FAMILY DWELLING
Location of Propert~ 4930 OUTH HARBOR ROAD SOu'r~OLD, N.Y.
House NO. Street Hamlet
County Tax Map No. 1000 Section 86 Block 3 Lot 3.5
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-23379 dated NOVEMBER 30, 1994
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
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTA~D INSPECTION REPORT.
Rev. 1/81
RUT~ EMERSON WORTIS
N/A
N/A
N/A
LOCATION: 4930 SOUTH ItARBOR ROAD
(number & street)
SUBDIVISION
NAME OF OWNER (s) -~ WORTIS
BOILDING DEPARTMENT
TOWN OF SOUTIIOLO
tlOUSING CODE INSPECTION REPORT
SOWFHOLD, NEW YORK
(municipality)
}U~P NO. LOT(s)
OCCUPANCY A- I RES.
(type) (owner-tenant)
ADltl't-r~O BY: FRARK ARNOLD ACCOMPANIEfi BY: SAHE
KEY AVAILABLE SUFF.CO. -tAX MAP NO. 1000-86-3-3.5
SOURCE OF REQUEST: CHARI,ES CUDOY, ATTY DATE: OCT. 26,
1994
DWELLING:
TYPE OF CONSTRUCTION
FOUNDATION
TOTAL ROOMS:
BATHROOM (s)
PORCR TX~E
BREEZEWAY '
DOMESTIC HOTWATER
T~¥E HEAT NONE
OTHER:
WOOD FRAME
CEmeNT BLOCK POSTS
IST FLRo ONE
ONE
FRONT COVERED
YES
CELLAR
2ND FLR.
TOILET ROOM (s)
RECK, TYPE
FIREPLACE ORE
TYPE HEATER EI, F-CTHIC
WARM AIR
# STORIES ONE
CRAWL SPACE
3RD FLR.
UTILITY ROOM
PATIO
GARAGE
AIRCONDITIONING
HOTWATER
EXITS ONE
ACCESSORY STRUCTuF, ES: NONE
GARAGE, TIME OF CONST.
SWIMMING POOL
OTItI~R:
STORAGE, TYPE CONST.
· GueST, TYPE CONST.
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFOR}i FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
INSPECTED BY
DATE OF INSPECTION OCTOBER 31, 1994
TINE START 10:30 END 12:30
Form No. 6 i
APPLICATION FOR CERTIFICATE OF OCCUPANCY
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 ail 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
Vpre-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 Buildinm - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . P~.~f.. ~ ~.. ~P~J ......
New Construction ......... Old Or Pre-existing Building .... ~ ......
South Harbor Road Sout~i~
Location of Property .... ~.~.~-~ ....................................... ... . . . . .... ..... · .. ·
House No. Street Hamlet
Ruth Emerson Wortis
Onwer or Owners of Property ............................................................. · · ...
-e-' 086 00 nlock 03.00 p~.00~.
County Tax Map No 1000, ~ c:mon ...... : ........................ Lot ..................
Subdivision........... .............. ....... .... Filed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant... Charles R. Cudds
Health Dept Approval Underwriters Approval .................
Planning Board Approval ...............
Request for: Temporary Certificate ........... Final Certicate..f ........
Fee Submitted: $ .............................
~ [Z)%-~37/ APPLICANT Charl~/9 R. Cuddy
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
SS.:
AFFIDAVIT
CHARLES R. CUDDY, being duly sworn, deposes and says:
I am the attorney for Ruth Emerson Wortis, who owns
certain premises off South Harbor Road, southold, New York, known
and described on the Suffolk County Tax Map as District 1000,
Section 086.00, Block 03.00, Lot 03.002.
The subject premises consists of approximately 1.4 acres
and contains a one story residence-cottage which has been used in
the summer by the owner. Annexed hereto is a copy of the survey
showing the subject parcel, as well as the adjoining parcels.
The records for the subject parcel reflect ownership in
the present owner's family prior to 1930 and the cottage at the
premises was constructed prior to 1957. This information was
provided to me by the owner, who is an out-of-state resident.
I make this affidavit in order to obtain a Certificate of
Occupancy on Pre-Existing Building for the building at this parcel
(Tax Map No. 1000-086.00-03.00-03.002).
As the attorney for the owner, permission is hereby given
for the building inspector to inspect the site and request is made
for the issuance of a Pre-Existing Use Certificate.
Sworn to before me this
~7~tday of October, 1994
4e2.25 3.
(Charles R. Cudd~
CHAI~LE~'~. CUDD¥
N~ary Public,'State of New York
N~.. 5872225
Oualifi~ in Suffolk County
Commission/Expires I~cemb~r 31,199~¢-