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Home My WebLink AboutZ-12485FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z1~485 Date ....... .M.ay. 23 1984 THIS CERTIFIES that the building ~.--Owelling & accessory shed Location of Property 4625 Private Road (Aldrich Lane Ext.) Mattituck County Tax Map No. ]000 Section ... ~-~ ...... Block ...0.1 .......... Lot . ....0.1.4 .......... Subdivision ...... .X. ....................... FiJed Map Ho...X. ..... Lot No...X ........... Requirements for a private one-family dwelling built prior to conforms substantially to the A~eaii~n-f~rr-Btfitd?ng-Permi~-h~t~ttff~re-~-in-this-uffiee-dllT~d Certificate of Occupancy ....3:.p.r..~.~..2.3. ........,19.5.7. pursuant to which Buiidireg-l~-nrit No ....... g. 1. .2 .4 .8. 5. ........ -dated ..... Ylay. 2.3 ............... 19 .8.4., 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 ......... a private one-family dwelling with accessory metal storage shed. The certificate is issued to WARREN & SUSAN CANNON ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval no record UNDERWRITERS CERTIFICATE NO. no record See attached Housing Code Inspection Report. Building Inspector Rev. 1/81 BUILDING DEPARTi. IENT TO~'~ OF SOUTHOLD, N. Y. HOUSING CODE INSPECTICN REPORT Location 4625 Private Rd. (Aldrich Lane Ext.) Mattituck (number & street~-- (~.tunicipatity) Subdivision x Map No.....x Lot(s) X Name of Owner(s) Warren & Susan Cannon Occupancy R-1 (type) A~itte~ by:.. Mrs. Key available Cannon owner [owner-~enan~)----------- Accompanied by:._, same _Suffolk Co. Tax No. 112-1-14 ?otlrce of request Mr. & Mrs. Cannon Date 4/29/84 Type of construction t blog~ & wood #stories 9 Foundation cement block Cellar_~Crawl space Total rooms, ]st. F1 5 2nd. F1 5rd. F1 Bathroom(s) 1 Toilet room(s) 1 rest Porch, type screened in Deck, type Breezeway Garage . Type Heat oil fired Warm Air i;z~. eplace(s) 2 No. Domestic hotwater yes Other ~ .:b:~,.~. STRUCTLr[{ES: Garage, type const. Swim,ming pool Other x 4 T)'pe heater Patio, ~e~ement Utility room Hetwater Airconditioning electric Storage, type const, metal Guest, type const. VIOLATIONS: Housing Code, Chapter 52 LncntiOncellar t Description no rail--cellar steps II 152-27-B Needs the electrical s~stem checked out V IAT1 r I R~.,arks. Inspected Ly: Curti~3~. Horton Date of Insp..,,,.,,Ma~ 3, 1984 FORM NO. 6 TOWN OF SOUTHOLD Building Depar[i,~ent Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation 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 completed site 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1.00 land use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..... ~ ................... New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property ?..~!?..~./.-~.....~..D....~.~..z-.~.~../..~'.W..../,.~.... £~T /t~ 4 ~-T, ......... House No. Street Ham/et Owner or Owners of Froperty v ... County Tax Map No. 1000 Section ....//..~.'.~..~. .... Block ...~./.'..~.~. ......Lot....~/..~.'..~. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $../.~.~...~..~ ..................... Construction on above described building an.al_permit m~_~s all applicable codes ar)d regulations. CONSENT TO INSPECTION /~/,~-,,'~,~',M ~. d~N~O~ ~ ~O~n~ ~, ~A~ , the undersigned, O~er(s) Name(s) do(es) hereby stale: That the unders~ned (is) (are) the owner(s) of the premises ~ the To~ ~~) ~~ ,vhich is shox~ and designated on the Suffo~ County tax map as District 1000, Section //~.~ a, Block m/. D~ , Lot ~/~. That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southold To~ Building Inspector's Office for the follow,g: 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. (signature) (print name) (signature) (print name) Title No. 8~08-02811 SURVEY FOR WARREN I~ CANON 8 SUSAN C CANON TOWN OF SOUT/'IOID SUFFOLK COUNTY, NEW YORK YOUNG e YOUNG R~,,YORK AND LAND SURVEYOR N.YS. LICENS£ N0.12845 fof~efly / :