HomeMy WebLinkAboutZ-25094FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXIETIN~
cl~TIFICATE OF OCCUPANCY
No Z-25094
Date JUNE 20~ 1997
THIS CERTIFIES that the buildin~
Location of Property 455 OBSEO AVE.
House No.
County Tax Map No. 1000 Section 87
subdivision
ON~ F~MILY
BOu-£~OLD~ N.Y.
Block
Filed Map No.
Street Hamlet
Lot 28
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-25094 dated ~u/~ 20~ 1997
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~ FAMILY D~.ING WITH A~E~ORY GARAGE *
The certificate is issued to l~,$IE BYRNES
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTAfN~ INSPECTION REPORT.
Rev. 1/81
LOCATION: 455 o~R~n AVE.
(number & street)
SUBDIVISION
NA~ OF O~NER (s) ELSIE BYRNES
BUILDING DBPAR~NT
~ OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
SOUlq~I~. N.Y.
(~unicipality)
~ NO. LOT(s)
OCCUPANCY
(type)
ADMITTED BY: GARY OLSEN
KEY AVAILABLE
SOURCE OF REQUEST: ' C. ARY OLSEN, ATTY
SINGLE FANILY
(o~mer-tenant)
ACCOHPANIED BY: SAM~
UOF~.CO. TAX NAP NO. 1000-87-3-28
DATE: JU[~ 12, 1997
IA~ELLING:
TYFE OF CONSTRUCTION
FOUNDATION BLOCK
TOTAL ROOHS: IST FLR.
BATBRO(~ ( s ) I
PORCH TYPE
BREEZEWAY
DOmeSTIC NOTWATER
TYPE HEAT
OTHER:
WOOD
CELLAR
2ND FLR.
TOILET RO(~ (s)
FIREPLACE
GAS TYP~ HEATER
OIL (HOT AIR) WASH AIR
# STORIES I-I/2 # EXITS
FULL CRAWL SPACE
3RDFLR.
UTILITY ROOH
BECK, TYPE P~IO
GARAGE
AIRCONDITIONIEG
BOTgATER
2
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.
S~II~IING POOL
OTHER:
Wt"IOB
STORAGE, TYPE CONST.
· GUEST, TYPE CONST.
VIOLATIONS: CBAPTER 45 N.Y. STATE UNIFORH FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ANT. SEC.
REHARES:
INSPECTED BY
MICHAEL J. VERITY
DATE OF INSPECTION JU~ 18, 1997
TII~ START 10:10 All END 10:50 All
FORM NO. 6
TOWN OF SOUTHOLD
· Building Department
Town Hall
Southoldo N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
· Instructions
A. This application must be filled in typewriter OR ink, and submitted ,,, ~ to the Building Inspec-
tor with the following; for new buildings or new usa:
1. Final survey of property with accurate location of ail. buHd!ngs, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal}.
3. Approval of electrical ins[aliatinn from Board of Fire Underwriters.
4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings and Installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the .building.
5.Submit planning Board approval of comp ated s te plan requirements where applicable.
B..For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
2.Sworn statement of owner or previous owner' as to u se, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:'
· 1. Certificate of occupancy $.25;'00 -- ~USINESS $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50 ,. 00
3. Copy of certificate of occupancy $'5;'00. ove= 5 'years ~;10.O0
4.V-~c=nt. T.ancl C.O. $~'20.00
0une 12, 1997
5. U.odat, ecT c.g. ~;"50.00 Date ..........................
NewConst,ruct'J-on ...... Old or Pre-existing Building . .X ........ '.. Vacant Land .............
Location of Property ,...4.5.5..0.s,~.e.o. ~.v~, o. ~;PP;~[~I ¢,. ~. ¥Ot'g ..............................
House No. Street Ham/et
Owner or Owners of Property El si e .K.: .B ~y .r' .n .e .s
tyT 2.8.
C~n ax Map No. 1000 Section ............. Block .............. Lot
Subdivision ' Filed Map No Lot No
Permit No Date of Permit Applicant
Health Dept. Approval ........................ Labor· Dept. Approval ........................
100 O0 '
/ /
...... :... .................. :. ///
ConstrUct.on on above described buildin~] and perm,! meo, t~ ;~Y'aoD LidJ)ble codes and regulations.
GAR'~FLANNER OL~EN, ESQ..
Rev, 10-1O.?S P.O. BOX 706
CUTCHOGUE, NY 11996
CONSENT
TO
INSPECTION
Gary Flanner Olsen, as Attorney for Elsie K. oByrnes
Owner(s) Name(s)
do(es) hereby state:
· the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at 455 Osseo Avenue, Southold, New York
...... which is shown and designated on the Suffolk
County tax map as District 1000, Section 87 , Block 3 , Lot 28
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in'th,~ Southold Town tiutlcling lnspet;r,,..~ otetoo to,, ~h,, tnllmvinff:
One and one-half story dwel]in§ and frame garage
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town 0f 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, fi~cludindTnspections
to determine that said premises comply with ali 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 ln/O~onduct of
/ I
such inspections may be used as evidence in subsequent pr~6secu~ons for yin-
- / /
lations ot the laws, ordinances, rules or regu~.
Dated: 3uae 32, 1997
('~j~nature)
Gary Fl anner Olsen as Attorney
(print name)
(signature)
(print name)
LOCAtI:~ AT ~ ou.-~v.,~ /
LOT ~ ~ ~ ~"~-"
MAP OF
SCALE 1"--'4
DRAWN BY
T'~'v /-or
SURVEYED U,4.~ Z.?, 19~7 BY
WILLIAM R. SIMMONS PI,LS.P.C.
11 MEROKE LANE
EAST 18LIP, LL, N.Y. 11730
(5'i8) 581-1888 Fa.x: (51&~
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