HomeMy WebLinkAboutZ-23103FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PP~ EXISTIN~
CERTIFICATE OF OGUU~'ANCY
No Z-23103 Date JULY 19, 1994
THIS CERTIFIES that the buildin~
Location of Property. 1745 WEST (~
House No. Street
County Tax Map No. 1000 Section 110 Block 2
Subdivision Filed Map No.
ONE F/%MILY DWELLING
N.Y.
Hamlet
Lot 4
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-23103 dated J~LY 19~ 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 ONE F~MILY DW~.ING WITH ACCESSORY GA~E*
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.
Rev. 1/81
JOSEPH E. & FRANC~S A. CAIN
N/A
N/A
N/A
ilding
LOCATION:
1745 WEST CREEK AVENUE
(number & street)
SUBDIVISION HAP NO.
NAME OF OWNER (s) JOSEPHE. & FRANC~S A.[CAIN
BUILDING DEPARTMENT
TOWN OF SOuTHOLD
HOUSING CODE INSPECTION REPORT
cFrCHOCUE, N.Y.
(municipality)
LOT(s)
OCCUPANCY SINGLE FAMILY DIALLING
(type)
ADMITTED BY: SUSAN SU'rl'ON
KEY AVAILABLE
SOURCE OF REQUEST: FRANCIS A. CAIN
(owner-tenant)
ACCOtdPANIEH BY:
SUFF.CO. TAXMAP NO. IOOu-~u-z-~
DATE: MAY 10, 1994
DWELLING:
TYPE OF CONSTRUCTION
FOUNDATION
TOTAL ROOMS:
BATHROOM (s)
PORCH TYPE
WOOD FRAI~
CEI~NT BLOCK CELLAR
IST FLR. 5 ' 2ND FLR. 2
2 TOILET ROOM (s)
BREEZEWAY IrKS FIREPLACE
DOMESTIC ROTWATER XX TYPE HEATER
TYPE HEAT OIL WARM AIR YES
OlUl~R: CELLAR OUTSIDE ENTRANC~
~ sToRIEs I-1/2~ EXITS
FULL CRAWL SPACE NONE
3RD FLR.
UTILITY ROOM NONE
BECK, TYPE P~}I'IO ~ PLACSI'ONE
YES GAP, AGE I CAR
LILCO GAS
AIRCONDITIONING NONE
ROIIIATER
2
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.
s~n~ING POOL
O1-ul~R:
STORAGE, TYPE CONST.
· GUEST, TYPE CONST.
VJ/1LATIONS: CHAPTER 45 N.Y. STATE IINIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY
DATE OF INSPECTION JULY 1, 1994
TLME START 9:35 END 10:05
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION 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.
B. 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 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
New Construction ........... Old Or Pre-existing Building ................ ~
Location of Property..Zl.~..~.....~..~-~.~..f~..~--~..~.~....~J.~.?.~.~.~y~ ~_~ ~ ~
House No. Street ~ Hamlet f
Onwer or O=ers of Property ....... g ~ ......... ~[. ~ ..... ~ .... ~''~
County T= Map No 1000, Section...~..Block..~.~ ....... Lot..~i~ ...............
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Pe~it ................ Applicant -.. . ~
Health Dept. Approval .......................... Unde~riters Ap~val ..................... ~ 7.-~
Planning Board Approval ........................
Request for: Temporary Certificate ..... Final Certicate ...........
Fee Submitted: $ .........................
Owner(s) Name(s)
do(es) hereby state:
CONSENT
TO
INSPECTION
t/ ,~///~P/~~, the undersigned.
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at / ? ~/~
County tax map as District 1000, Section /CDt . Block //O . Lot ~ ~
That the undersigned (has) (have) filed, or caused ~o be filed, an applica-
tion in the Southold To~ Building Inspector's Office for the follow.g:
· which is shown and designated on the Suffolk
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: t~/ /lJz/~y-
:/
(signature)
(print name)
(si~'nat~e)
(print n~me)
./
tiUe oon4~e~y, gowen',me~ml ege~cy ~nd