HomeMy WebLinkAboutZ-34482FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 34482 Date: 07/28/10
THIS C~TIFIES that the building DWELLING
Location of Property 1495 FOUNDERS PATH SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map NO. 473889 Section 064 Block 0004 Lot 016
Su]~division Filed Map No. Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 purs,,~nt to which CERTIFICATE OF
OCCUPANc"fl~I]MB~ Z- 34482 dated JULY 28, 2010
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 A~LICE JACOBI
of the aforesaid building.
( OWNER )
SUFFOLK COUNTYDEPART~TrOF HEALT~APPRO~-AL
ELECTRICAL c~KTIFICATE NO.
~LD~ERS U~U(TIFICATION Da'r~u3
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
~zed Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
NOUSING CODE INSPECTION REPORT
SOUTHOLD
MAP NO.: ~OT (S)
ALICE JACOBI
0.0
1.0 % EXITS: 2
PATIO TYPE:
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE pREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
~: BP 10124 SHED COZ 9475
1.
lines, streets, and unusual natural or
2/10 of 1% lead.,
and instadla~ions, a 0ertificate
for ~ building.
,r topographic
features. ' ' -. . '
2. Ap~roperly completed applicatio~ mzd. e~oment to inspect ~igned by thh applicant. If a Ceafifica~ of Occupancy is
denied, the Building I~'pector shall state the' reasons tl~emf0r in Writing to the applicant.
~. Fe~s
I.
Certifi,a~ of 0ceupa;Xcy -:,Blew ~tw¢ltiag $25.00, Additio .m, to dweBMg ~5.00, M~tio~ m dwel~ $25.~,
' Sw~g po01 $~5~00~ ~ess0~u~~ $25.~; A~fiom-{o ac~ss0~ b~g $25.00, Bm~ess~ $50.00.
3. CopYofC~0~O~cY - $.25 .
5. Temp~ C~ficme of O~up~cy - Residential $15.00, Commewi~ $15.00
Permit No.
Health Dopt. Approval:
· Planning Board Approval:
Date.
~New Construction: - . . 'Old or Preexisting Building: ~ (check One)
OWner or Ow~aers of'Proper}y: ', ~C~ ~'t0~7'~-c ~
· Suffolk County Taxh[ap~No ]:O00, Section b q Block· .' /~/
Subdivisio: ~00~/~,.~' ~'7,~.-/,~q T(~e' FiledMap.
Date Of P~miL Applicant:
Hamlet
Underwriters Approval:
Final Certificate:
Lot
Lot:
/6
(cheek one)
Applicant Si~amre
CONSENT TO INSPECTION
TOWN OF SOUTHOLD I~OPERTY RECORD_CARD
OWNER
FORMER OWNE~R z
VILLAGE
DISTRICT SUB.
ACREAGE
S W TYPE OF BUILDING
I
RES. ~ Z~) SEAS. VL. FARM cOMM. lIND. CB. I MISC. Est, Mkt. Value
LAND IMP. TOTAL DATE
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE FRONTAGE ON WATER
Farm Acre Value Per Acre Value FRONTAGE ON ROAD
Tillable 1
Tillable 2
Tillable, 3
Woodland
Swampland
Brushland
House Plot
Total
BULKHEAD
DOCK
Extension Basement ~")(X .f + Floors
Extension Ext. Walls (~%~ ~J/1 Interior Finish
Extension Fire Place ~x~ 0 Heat
Porch Roof Type
Porch Roo~ 1st Floor
Breezeway Patio Rooms 2nd Floor
Garage Driveway Dormer
o. ~. /~ z~~
LOCATION:
(number & street)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
ADMITTED BY:
KEY AVAH,ABLE:
SOURCE OF REQUEST:
(municipality)
(type) 6/ (owner-tenant)
ACCOMPANIED BY: '
SUFF. CO. TAX MAP NO. 1000-
~ DATE:
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION:
TOTAL ROOMS: 1ST FLR:
BATHROOM(S): I
PORCH TYPE:
BREEZEWAY:
2ND FLR:
TOILET ROOM(S):
DECK, TYPE: '.
FIREPLACE: /t/O
DOMESTIC HOTWATER: ")/~TYPE HEATER:
TYPE HEAT: o ]/.-.- WARM AIR: _
OTHER:
# STORIES: [ # EX/TS:
CELLAR: ~'~2 CRAWL SPACE:
3RD FLR: '- -
UTILITY ROOM:
PATIO, TYPE:
GARAGE: --
AIRCONDITIONING:
HOTWATER:
ACCESSORYSTRUCTURES:
GARAGE, TYPE OFCONST.:
SWIMMINGPOOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION
~ DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY: ~nr;,-~ DATE 0F INSPECTiON:
'7)- 9-3 ,'-/o
TIME START: END: