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Home My WebLink AboutZ-23711FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTNENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-23711 Date JUNE 16, 1995 THIS CERTIFIES that the building Location of Property 570 PEQUASH AVENUE House No. Street County Tax Map No. 1000 Section 103 Block 11 Subdivision Filed Map No. ORE FAMILY DWELLING Hamlet Lot 3 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-23711 dated JUNE 16, 1995 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 HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. WILLIAM & EMILY BO~KOWSKI N/A N/A N/A /Inspector Rev. 1/81 LOCATION: 570 PEQUASH AVR. (number & street) SUBDIVISION HAP NO. NAHE OF OWNER (s) WlLLIAI4 & EI4ILY BORKOWSKI BUILDING DEPARTHENT TOWN OF SOUTIIOLD IIOUSING CODE INSPECTION REPORT cIrrcHo~UE, NEW YORK (municipality) LOT(s) OCCUPANCY (type) (owner-tenant) ADHITTED BY: LAWRENCE BORKOWSKI ACCOHPANIED BY: fiAl~g KEY AVAILABLE SUFF.CO. TAX HAP NO. SOURCE OF REQUEST: WILLIAI~ & EMILY BORKOWSKI DATE: JAN. 20, 1995 DWELLING: TYPE OF CONSTRUCTION WOOD FRANE FOUNDATION CEI4ENT BLOCK TOTAL ROOHS: IST FLR. BATHROOH (s) ONE PORCtt TYPE FRONT COVERED BREEZEWAY DOHESTIC HOTWATE R TYPE HEAT OTHER: CELLAR FULL 3 2ND FLR. 3 3RD FLR. TOILET ROOM (s) ONE FIREPLACE TYPE tIEATER WAP, H AIR BECK, TYPE ONE OFF BOILER PANTRY OFF KITCHEN, REAR ENTRY WAY STORIES 2 ! EXITS 2 CRAUL SPACE UTILITY ROOM PATIO GARAGE AIRCONDITIONING tlOT~ATER ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. S~IFI)IING POOL OTHER: 2 CAR WOOD F~ STORAGE, TYPE CONST. · GUEST, TYPE CONST. NONE VIOLATIONS: CItAPTER 65 N.Y. STATE UNIFOR~ FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. INEP~CTED BY DATE OF INSPECTION 1/31/95 & 6/9/95 TIHE START 9:25 END 9:50 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOI~N tlALL 765-1802 ~kPPLICATION FOR CERTIFICATE OF OCCUPANCY 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 lihes, 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 "pre-existing" land uses: i. 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 Buildin~ - $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 ................ ~. .. New Construction ...... [..~ Old Or Pre-existing Building..~ ...... Loeation of Property...£Z .... House No. Street Hamlet County Tax Map No 1000, Section...t 5. ...... Bloc ...l! ........... Lot.. . .................. Subdivision ............................ Filed .. . ........ Map Lot Permit No .............. Date Of Permit ........... Applicant ...................... ith D pt Appr 1 i{ea e . ova ...... .................... Underwriters Approval .......... 'lanning Board Approval .................... (equest for: Temporary Certificate ........... Final Certicate ........... APPLICANT~ · ' ' Ox;qmr (s) do(~l~ hereby state: CONSENT TO INSPECTION Name(s) the undersigned, That the undersigned (~.) (are) the owner(s) of the premises in the Town of Southold located · which is shown and designated on the Suffolk County tax map as District 1000, Section That the undersigned (1~ (have) filed, or ~aused to be filed, an applica- tion in the Southold Town I3uilding Inspector's Office for th.~ following: That the undersigned do(~,~ 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 xvith respect to the aforesaid 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(::~ so xvith the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. (signature) (print name) (t~r iht name) THE NEW YORK BOARD OF FIRE UNDERWRITERS 8~54413 BUREAU OF= EI. ECTRICITY ~'- E3 JOHH STREET. HEW YORK. NEW YORK 10038 ~,~ JU~ O6,1995 4p~atlo. ~o. o./il. 07245895/95 H 045746 THIS CERTIFIES THAT WI~ ~, 57G P~H A~., ~, N.Y. 26,1995 and found to be in compliance setth the National Electrical Code. AMT. K.W. OJL N.,. GA5 H.P. .,v~ mCO~NF:T .o.O, S , R EXHAUST FANS mMMERS WlrI.T.TI~ 129 CAM-A-WTI.I. CIRCLE STONY POINT, NC, 28678 11 This certificate must not be aheced in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THiS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.