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Home My WebLink AboutZ-23136FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. P~E EXISTIN~ ~TIFI~ATE OF O~uu~AN~Y No $-23136 Date AUGUST 2, 1994 THIS CERTIFIES that the building Location of Property 9525 MAIN House No. County Tax Map No. 1000 Section 122 Subdivision FAMILY MATTITUCKr N.Y. Street Hamlet Block 06 Lot 13 Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: A~IL 9r 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-23136 dated A~ST 2~ 1994 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 ON~ F~MILYD~-TN~WITHA~CES~O~X CEMENT BLO~KSTORA~E The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTA'~ INSPECTION RMPORT. Rev. 1/81 /+~Bu~ild~ing~Inspector BUILDING DEPARTHENT TONN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 9525 HAIN ROAD (number & street) SUBDIVISION HAP NO. NAI~ OF OWNER (s) ~ ~OURSIQUOT & WIFE NITIIIIICI(~ l~¥Ol~ (auuicipality) LUT(s) OCCUPANCY A-I RES. ~R (type) (ovner-tenant) ADMITTED BY: BAI~ARA BOURSIQUOT ACCO~fPANIED BY: SAHE KEY AVAILABLE SUFF.CO. TAX HAP NO. 1000-122-06-13 SOURCE OF REQUEST: B~RRARABOURSIQUOT DATE: JULY 15, DWELLING: TYFE OF CONSTRUCTION FOUNDATION TOTAL ROONS: BATHROOH (s) PORCH TYPE BREEZEWAY DOHESTIC HO~ATER · YrE HEAT ELECTRIC WOOD ~ ~ STORIES CElfl[NT BLOCK PIERS CELLAR NORE CRAWL SPACE IST FLR. 4 2ND FLR. 3RD FLR. ONE TOILET ~ (s) UTILITY ROOH BECK, TYPE PATIO I # EXITS 2 FIREPLACE GARAG~ YES TYPE HEATER ELECTRIC AIRCONDITIONING WARN AIR HOT~ATER ~£1tiIR: ACCESSORY STRUCTu~S: GARAGE, T~FE OF, CONST. STORAGE, TYFE CONST. ClieNT BLOCK BUILDING SITI1OfING POOL , GUEST, TYPE CONST. ~l'~R: TRAILER - 4 RO0~S, OIL UEAT, ELECTRIC HOT~ATERI~I~ATER - ! BATItRO(~- 2 EXITS VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFOI1N FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. INSPECTED BY DATE OF INSPECTION JULY 20, 1994 TINE START 10:00 AN END Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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. 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. Couunercial 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: 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. 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 '~. 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 ..... New Construction ......... Old Or Pre-existing BuildingS. ................ Location of Property, ][ .~.~...~ ..... ~/~'. ~.~.../~./~...V~-_~. ~.~.../.~..~.~..~.. ....... House No. Street Hamlet Onwer or Owners of Property ........................ ~ ............................. County Tax ~p No I000, Section..]~ ...... Block .... & ......... Lot ..... ~ ............. Subdivision ............................... ..... Filed Map ............ Lot ...................... ............... Date Of Permit ................ Applicant ............................. Permit No . ]ealth Dept. Approval ........................ · . Underwriters Approval .................... ..... ~lanning Board Approval ................ ~quest for: Temporary Certificate .... Submitted: $ ....... Final Cer ticate ...... ... CONSENT TO INSPECTION ' / Ow~er(s) Name(s)' ' do(es) hereby state: That the undersigned (is) (are) the owner(s) of tile premises in the Town which is sho%~n and designated on the Suffolk County ta× map as District 000, Section . That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southold Tox%~n Building Inspector's Office for the ~ollowing: 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 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(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 vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: " ~/(s~ign~r e) -(.~rmt u ~*e J~ (print name) C.,o~9'