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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-
32219
Date: 03/05/07
THIS CERTIFIES that the building
DWELLING
Location of Property 230 PEQUASH
(HOUSE NO.)
County Tax Map No. 473889 Section 102
AVE
(STREET)
Block 0003
CUTCHOGUE
(HAMLET)
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-
32219
dated MARCH
5, 2007
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 JOHN E DAWSON
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
N/A
N/A
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
~~-
Au horized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION:
230 PEQUASH AVE
CUTCHOGUE
SUBDIVISIOll:
MAP RO.:
LOT (S)
HAMB OF OHHER (S): JOHN E DAWSON
OCCUPANCY: SINGLE FAMILY DWELLING
JOHN E DAWSON
ADMITTED BY: MARY HOLLAND
ACCOMPANIED BY: SAME
KEY AVAILABLE:
BUFF. CO. TAX MAP RO.: 102.-3-2
SOURCE OF REQUEST; ABIGAIL WICKHAM, ATTY 2/23/07
DATE: 03/05/07
DWELLING:
TYPE OF COllSTRUCTIOll:
WOOD FRAME
It STORIES: ~ It EXITS: 3
FOillIDATIOH :
CEMENT BLOCK
CELLAR: FULL
CRAWL SPACE:
TOTAL ROOMS; 1ST FLR.; ---1.
2lID FLR.: ---1.
3RD FLR.; --9.
BATHROOM (S) : 1. 0
TOILET ROOM (S) : 0 . 0
UTILITY ROOM(S) :
PORCH TYPE; ROOFED OVER
DECK TYPE:
PATIO TYPE;
BREBZBWAY:
FIREPLACE:
NO
GARAGE ,
DOMESTIC HO"l'WATER: XX
TYPE BEATER: OIL BURNER
AIRCOHDITIOHIHG:
TYPE BEAT:
OIL
WARM AIR:
YES
HOTWATER: YES
OTHER: SEPARATE HOT WATER HEATER
ACCESSORY STRUCTURES:
GARAGE. TYPE OF COHST.:
STORAGE. TYPE COHST.:
ACCESSORY SHED
SWIMMIRG POOL:
GUEST. TYPE COHST.:
OTHER ,
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION
DESCRIPTION
ART.
SEC.
REMARKS ,
~ *~ DATE ON INSPECTION, 02/28/07
IRSPBCTlID BY:
GEORGE GILLEN
TIME START:
END,
.L V.L.U'
.232[1::;
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPA1;CY
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 17. 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.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-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
r reasons therefor in writing to the applicant.
C . ~,=es
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 - $100.00
3. Copy of Certificate of Occupancy - ~. .2~.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy Residential $15.00, Commercial $15.00
Date ..~~~~~~~%.t~,.~QQ?.....................
N C t. Old 0 P .. B 'ld' X (for a two story frame dwelling)
ew onstruc ~on........... r re-~~~st~ng u~ lng.................
Location of Property.. .~~Q..................... .~~g,;,~~l}.1-Y~r:,;,,,............ .~'!~~!t?15!'!'.........
House No. Street Hamlet
Onwer or Owners of Property. ..:['!I}r: .~~~~'!~ .r!'!'1~C:'!-. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . .
County Tax Map No
1000, Section....tQ~:QQ....Block..Q~:QQ.........Lot...99?:~~~............
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map........... .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No............... .Date Of Permit............... .Applicant. . .. . . .. . ......... . . .. . . . .. ..
Health Dept. ApprovaL........................ .Underwriters ApprovaL........................
Planning Board Approval........................
Request for:
Temporary Certificate........... Final Certicate.....~.....
$.~QQ:........................ ;,;1/ ,J/) ~ - ..
~ -~. .~... '#1:it{f1(f:/q/I~............
Abigail A. Wickham, Agent
Fee Submitted:
~.tC-. 7 f 7 tr
&,/llLCO r:.32:)/r
10131 2-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON
REMARKS. ~.~
DATE 3 -- / S - 0 7
INSPECTOR
~~
,
CONSENT
TO
INSPECTION
John Elliot Dawson
Owner(s) Name(s)
do(es) hereby state:
, the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at 230 Pequash Avenue, Cutchogue, NY 11935
, which is shown and designated on the Suffolk
County tax map as District 1000, Section 102 ,Block 3
, Lot 2
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: a
,
two story frame dwelling.
That the undersigned doles) 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,lrules
and regulations of the Town of Southold.
The undersigned, in consenting to such inspactions, doles) 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-
rules or regulations of the Town of Southold.
! /
/
',' ,'1" ,
'~ .
s g
lations of the laws, ordinances,
Dated: 2/16/07
Abi~ail A. Wickham, Agent
print name)
(signature)
(print name)
( \
TOWN OF SOUTHOLD PROPERTY RECORD CARD
;V1~0'
IdtJa -/,,~-3-.2.
OWNER STREET 23 () VILLAGE DIST. SUB. LOT .
~#AI i:~ DAWSOtV , Pe<l.V3Jh Ave, C I./kk (JQ ve- ld.., DefC,
FORMER OWNER N , E v ACR.
tV; ilL //INP P.e.Qu..~sJ.. fJ,).e- ^ ~;> C;
,J1fJD~L/1{ f'. RIJRtnW S W TYPE OF BUILDING c
1M .:..d Cl L I A. r. ~ .;r: <I M
921d SEAS. VL FARM COMM. CB. MISe. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
2706 1/!;3/7-1 SoLo./t~oo ,~'LlJ /'7. 73Af,h,qU L 77.j",p'
~ot) j :l.o t"'\ ~ 10 J. Dfhv$O IV /~ /1
I.()~ .3 '" P"'(> l,? "0-"0 .J 1//1"/77. '/~"'/'a .6'?//O/3Q l 1.4/./ ~r,<>"I""6< :I, do.. II ,F,(' '/I,so v"',JI(c
\ )'
~
AGE . BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM 'Acre Value Per Value
Acre
Tillable 1 , '
nllable 2
rillable 3 ,
Noodland ,
;wampland FRONTAGE ON WATER ..
lrushland FRONT AGE ON ROAD 7-y -fft {!J ~ p'" ,- &"'0
.' 2JJ 0 4' -1-1
-louse Plot DEPTH
~ ........~ ..... BULKHEAD
....,
'otal DOCK .
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~tensjon S"X i:. "" "3 0 l-~ 7S- Basement rill '- Floors t) "'1 ,'(, K,
Extension ~. Wolls Interior Finish LR,
cxt, WOO'" <:""N c.. bJl'JJ.-J-. I'J.P
Extension I=ire Place /1 ~. Heat -..JEs DR,
tr ype Roof Rooms 1st Floor I
SR.
Porch 1''1:13 : /2-.1 s;-u ,?y ~ecreation Room Rooms 2nd Floor FIN, B.
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Breezeway riveway
Garoge r
Patio
O. B.
Total .3 y:.3 .J / .
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