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Home My WebLink AboutZ-29727 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 29727 Date: 09/22/03 THIS CERTIFIES that the building DWELLING Location of Property 1392 PARK AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 123 Block 0008 Lot 002 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- 29727 dated SEPTEMBER 22, 2003 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 WITH ACCESSORY TWO CAR GARAGE WITH ATTACHED STORAGE ROOM. The certificate is issued to ADRIAN L EDWARDS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATBD N/A *PLEASE SEE ATTACHED INSPECTION REPORT. ~ ~ utho zed S'gnature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT IgCATION: 1392 PARK AVE MATTITUCK SUBDIVISION: HAP NO.: LOT (S) NAN6 OP OMNffit (S): ADRIAN L EDWARDS OCCUPANCY: SINGLE FAMILY DWELLING ADRIAN L EDWARDS ADNITTHD BY: JOAN HAMILTON ACCOMPANIHD BY: SAME XHY AVAILABLE: SUFF. CO. TAX NAP NO.: 123.-8-2 SOURCH OP RHQII6ST: SENNIFER GOULD, ATTY 9/12/03 DATE: 09/22/03 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME # STORMS: 2.0 # S7CITS: 3 PODHDATION: CONCRETE, BRICK & STONE CHLLAR: FULL CAANL SPACE: TOTAL ROOMS: 1ST PLR.: 4 2ND FLA.: 4 3RD PLR.: 0 BATHROOM(S): 2.0 TOILSP ROOM(S): 1.0 UTILITY ROOM(S): POACH TYPH: COVERED DHCR TYPE: PATIO TYPH: BRHHZHWAY: PIRHPLACH: 3 GARAGH: DOMESTIC HOTWATBR: YES TYPH HHATSR: OFF BOILER AIRCONDITIONING: TYPB HEAT: OIL NARK AIR: HOTNATHR: XX OTBHR: ACCESSORY STRUCTURES: GARAGH, TYPH OF CONST.: 2 CAR W/ATTACHED STORAGE STORAGH, TYPH CONST.: SNII4IING POOL: GUEST, TYPH CONST.: OTHSA: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION ~ DESCRIPTION ~ ART. ~ SEC. RHMARRS: INSPECTED BY: DATH ON INSPHCTION: 09/18/03 GARY J. I TIME START: 9:30 AM %ND: 10:00 AM 1 FormNo.6 TOWN OF SOUTHOLD ` ~ ~ , BUILDING DEPARTMENT TOWN HALL 765-1802 ~ 2 APPLICATION FOR CERTIFICATE OF OCCUPgNCY. ~ This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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 fi om architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-cmrforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and amisual natural or topographic features. 2. A properl~~ completed application and consuri to inspect signed b~~ die applicant. If a Certiflyde oi~Occupancy is denied, the Building Inspector shall stale the rcasous therefor in writing to the applicant. C. lees 1. Certificate ofOccupancy -New dwelling $25.OQ, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinuning pool $2>.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. j(r 2_ Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4 Updated Ce~tificale of Occupancy - $50.00 5. "femporap Certificate of Occupanc~~ - Residential $15.00, Conunercial $15.00 [Date. q-10- Z~0'3 Ncw Construction: Old or Pre-existing Building: (check one) Location ofProperty:_ ~~Jq2. ~Q2C 1~U~PIIbIQ.. YViCi-fft'tuC~ House No. Street Hamlet ~ r ram rQC-E Owner or Owners of Properly: _ Cifi G n L - E~ Wq r~ g + ~(A6'1i2, ~~'S~(~ Suffolk County Tax Map No 1000, Section I .'t'3 ..D O Block p$' Op Lot 002 , Ap 2~ II - t- tA~s Subdivision ,{1? R:~f'rt1. -Foot rti. t~i- tz Filed Map. _ 4.SD Lot: ~p _rp ~ 3 Permit No. ~ (a- Date of Permit. u ! a.. Applicant: ?J (C~ Health Dept. Approval: N / 0.- Underwriters Approval: Plamiing Board Approval: Request for: Temporary Certificate Final Certificate: ~ (check one) Fee Subrnitted: $ ~ D O Ap 'cant Signature ~ Y 732 ~i~e.co~~9~~7 ~ r _ G? ~ 2 ~ l , Adrian L. Edwards, M. D. 1 ~ ~ I 4932 Spur Ridge Road ' .7,'~ Las Cruces, New Mexico 88011-9342 ~ ~ (505) 521-1485 September 19, 2003 Re: 1392 Park Ave., Mattituck, NY, 11952 Mr. Gary Fish Building Inspector, Town of Southold P.O. Box 1179 Southold, NY 11971 Dear Mr. Fish: This notarized letter certifies that there have not been any plumbing changes made to the above mentioned property since I purchased it in 1978. The bathroom off the master bedroom on the second floor existed at the time of purchase. The sink and shower fixtures were replaced in 1982. The bathroom in the kitchen area also existed at the time of purchase and has not been changed. If there is any other information that I can supply, please do not hesitate to request it. mcere yours, l.~ii~ Adrian L. Edwards, MD Subscribed and Sworn before me on this 19th day of September, 2003 ~C My Commission Expires on C„ J 6-28-07 Notar t0'd '1ti101 FROM ;3 C,OllLD ESid FHK tvu. :esla~itbal Sep. xa doss aa:5tirri rs CANSENTTp[NSPBCTION Cbllltac`t 4'4ttsrr~It~ona CP11 iL ~35-6Z.1 I -1Q SrC1AFd u.lR.. A PpJ~ M mPA"t , _~d 2 ra~_~~ t?Wp rdS, the undersigned, do(e~~) hereby state: C)wner(sl Name(s) That, the und~7signed (is) (arc) the nwner(s} of the premises in the'Town of Southold, located at__139Z Qt jj~on~~n H1Q}fr~+rac~,,.~1~: 11`1s'Z-~ which is shown and dcsi~tatcd on the Suffolk County Tax Map as District t OOQ, Section I31ock Lot That the undersigned (has} (have} filed, or cause to be filed, an application in the Southold Town Building ]nspector's Of'ficc for the fallowing: - p ,_s-t~..` That the undersigned do(es) hereby give consort 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 khe aforesaid application, including inspections to determine that said premises comply with all of the laws, otdinanccs, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, doles} so with the knowledge and understanding that any infomtatian obtained in the conduct of such inspectionv may be used iri subsequent prosecutions for violations of the laws, ordinances, toles or regulations of the Tnwn of Southold. ~~daw 1, C~M44~~If betted: ~~14,e3 ~y : ~ _ _ tgnaturc) Ai4•~q•~t~r en. 1N.w•~ 4l Q,yi$ 1}. rash (signature) taco) 68:- eau (Printlvame) !A}~a.~ t0~L0'd 9025 5b6 ZLZ ddOQI~tiQ JOlNtj~1 90:Lt X002-0t-d3S