HomeMy WebLinkAboutZ-23940FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Pl~ F/IETIN~
~RTIFI~AT~ OF OC~u~CY
No E-23940
Date OCTOBER 6, 1995
THIS CERTIFIES that the building
Location of Property 2840 BA~AVENUE
House No.
County Tax Map NO. 1000 Section 144
Subdivision
ONE FP~MILY D~.?.IN~
Block 3
Filed Map No.
MATTITUCK, N.Y.
Street Hamlet
Lot 21
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-23940 dated O~TOBER 6~ 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 GARAGE *
The certificate is issued to JOHN R. BRICE & DAVID W.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
H/A
H/A
*PT.R~SE SEE ATTA~D INSPECTION REPORT.
~ui~ding Inspector
Rev. 1/81
LOCATION: 2840 BAY AVENUE
(number & street)
SUBDIVISION
NAME OF O~NEE (s) JOHN BRICE
BUILDING I)EPAR'I~IENT
TOWN OF SOUTDOI.D
IIOUSING CODE INSPECTION REPORT
MATTITUCK, NEW YORK
(municipality)
MAP NO. LOT(s)
OCCUPANCY A-!
(type)
ADHITTED BY: JOHN DeREEDER
KEY AVAILABLE
SOURCE OF REQUEST: JOHN BRICE
O~mER
(owner-tenant)
ACCONPANIED BY: SAI~
SUFF.CO. TAX NAP NO. ]000-144-03-2!
DATE: 9/11/95
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME
FOUNDATION ~,~...~.._.~.LOCK & POURED CliLI.AE PARTIAL
TOTAL ROOMS: mST FLR. 6 2ND FLR. - - 3RD FLR.
BATIIROOM (s) ONE
PORCN TYPE
STORIES ONE ~ EXITS ~O
TOIl. ET ROOI4 (s)
DECK, 'I~/PE
CRAWL SPACE
DTILITY ROOM
ptL~ioREAR C~lf[ PATIO &
BREEZEWAY FIREPlaCE
DOMESTIC HOTWATER YES TYPE HEATER
TYPE NEAT OIL WAP, H AIR
OTIIER:
LILCO GAS
GARAGE
AIRCONDITIONING
NOTWATER' XX
ACCESSORY STRUCTURES:
GARAGE· TYPE OF CONST.
SWII~4ING POOL
OTHER:
I CAR WOOD FRAI4E STORAGE, TYPE CONST.
· GUEST, TYPE CONST.
VIOLATIONS: CNAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART.
REMARKS:
INSPECTED BY
DATE OF INSPECTION SEPT. 29, 1995
TIHE START I0:00 END 10:30
~LOG. DEPT,
~ OF SO~'T~OLD
TOWS oF SOUTUOLD
BUILDING D EPARTMENT~#
TOWN HALL
765-[802
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:
i. 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-? form).
3. Approval of electrical installation from Board of Fire Underwriters.
Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of i% 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:
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.
i. Certificate of Occupancy - New dweiling $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-existin~ Buildiet - $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
New Construction ........... Old Or Pre-existing Building
Location of Property..Z.~..~ .............. .~...~.~ ..... .~..~..~. ......... .~...~..~...~./..~..~..~./..~ .....
House No. Street llamlet
Onwer or Owners of Property~./~...~.~../~. ~ ~.2.,
........... .
:ount Tax No ,tooo, Snctio,.! Y ......... ........... ............
Subdivision .................................... Filed Hup ............ Lot ......................
?trait No ................ Date Of Permit ................ Applicunt .............................
:ieaith Dept. Approval .......................... Underwriters Approval .........................
'fanning Board Approval ........................
:lequest for: Temporary Certificate ........... Final CerticaCe ...........
e~ Submitted: $. ~.~. (~ ........................ ,~..~....~~
!
Owner(s) Name(sY'
do(es) hereby state:
CONSENT
TO
INSPEC'rlON ['
~LOC,
the undersigned,
That the undersigned (is) (are) tile owner(s) of the premises in the Tow~
of Southold located at
· x~htcn is shown and desifnated on the Suffolk
County tax map as District 1000, Section /~/~/ , Block ~,~) , Lot
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:
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
aeem 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 rio-
lations of the laws, ordinances, rules or regulations of the Town of Southold.
Dated:
'/ / 'g ture)
(signature)
(print name)
OF .~
MAP OF
SITUATED
MA T TI TUCK
TOWAl OF SOUTHOLD
SUFFOLK CO.,Al. Y.
BLDG. DEPT.