HomeMy WebLinkAboutZ-22774FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-22774
Date DECEMBER 9~ 1993
THIS CERTIFIES that the buildin~
Location of Property 3895 WELLS AVE.
House No.
County Tax Map No. 1000 Section 70
Subdivision
ONE FAMILY DWELLING
SOUTHOLD~ NEW YORK
Street Hamlet
Block 4 Lot 2
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-22774 dated DECEMBER 9~ 1993
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 *
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HF~kLTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
JOAN ALBERTSON ROGERS & ORS. AS TRUSTEES
N/a
N/A
ing Inspector
LOCATION:
SUBDIVISION
NAM~ OF OWNER (s)
BUILDING DEPART}~NT
TOWN OF SOU~[0LD
}lOUSING CODE INSPECTION REPORT
3895 WELLS AVE. SO0~OLO, NEW YORK
(number & street) --
(municipality
MAp NO. LOT (s)
JOAN ALBERTSON ROGERS & ORS., AS TRUSTEES
OCCUPANCY A-1
(type)
ADMIi-rED BY: MR. ROGERS
KEY AVAILABLE
SOULCa OF REQUEST:
(Owner-tenant)
S~
ACC0~'ANIED BY:
StJ~'~. £0. TAX HAP NO. 1000-70-4-2
JO~uN ALBERTSOR ROGERS DATE: DEE. I ·
1993
DWELLING:
IX~E OF CONSTRUCTION
FOUNDATION
TOTAL ROOMS:
BATI/ROOM (s)
WOOD FRAME
CEMENT BLOCK
IST FLR. 4 2ND FLR.
2 FIILL BATH' TOILET ROOM (s)
PORCH TYPE ENCLOSED PORCH DECK, TYPE WOOD
BREEZEWAY FIREPLACE ONE
D0~STIC U0~ATER YES. TYPE HEATER OFF BOILER
TYPE ItEAT OIL ~DEA~AiR aa
~ STORIES ONE
CELLAR FULL
3RD FLR.
UTILITY ROOM
PATIO, TYPE
GARAGE
AIRCONDITIONING
HOTWATER
# EXITS 2
CRAWL SPACE
ACCESSORY STRDuiuKES:
GARAGE, TYPE OF C0NST.
S~IMMING POOL
O~R:
2 CAR, WOOD FRAME STORAGE, TYPE CONST.
· GUEST, TYPE CONST.
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ,~RT. I SEC.
REMARKS:
INSPECTED BY:
Gary//~ Figh
DATE ON INSPECTION UECIg~BER 8,'1993
TIME START 9:40AM ENI~ I0:00 AM
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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.
2o 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.
Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
Submit Planning Board Approval of completed site plan requirements.
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
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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . ./.~ 7 f./.%?,~ ....................
LocationNeW ConstructiOnof Property~..~........Old Or Pre-existinz Building~....~'~.~. .~. ...~..~.............................t~ , ,~ ~' ~. ''' ~......~''.
House No. Street Hamlet
County Tax Map No 1000, Section.~.~f.CZ~ .... Block.~ ........ Lot...~.~&~ ..........
Subdivision .................................. · · Filed Map ......... ... Lot..~ ................. . .
Permit No .............. .. Date Of Permit ................ Applicant ......................... .. . .
Health Dept. Approval ........................ · · Underwriters Approval .........................
Planning Board Approval ..................... .. .
Request for: Temporary Certificate ........... Final Certicate..~ .......
Fee Submitted: $ .... [.~0 ~ f~ ~~~
.......................
ff ......... t;t ................................
~PLIC~T
CONSENT
TO
INSPECTION
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in thc Town
&~ 4) ~ ~v r ~' /d ? fl/ which is shox~ and designated on the Suffolk
County tax map as District 1000. Section m~o,~¢~, Block Oqge, Lot ~o7.
That the undersigned (has) (have) flied, Or caused to be filed, an applica-
tion in the Southold Tox~m Building Inspector's Office for the follow.g:
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 aferesaid 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 ~io-
lations of the laws, ordinances, rules or reg-ulations of the Town of Southold.
Dated: /2 )
! !
(signature)
(print name)
(signature)
(print name)
\VELLS