HomeMy WebLinkAboutZ-19906FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-19906 Date MAY 15r 1991
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1200 EAST MILL ROAD
House No. Street
County Tax Map No. 1000 Section 107 Block 1 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for A Private One Family
Dwelling built prior to: APRIL 9r 1957 pursuant to which
MATTITUCK f N.Y.
Hamlet
CERTIFICATE OF OCC. #Z-19906 dated MAY 15~ 1991
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 2 CAR WOOD FRAME GARAGE *
The certificate is issued to JAMES H. COHILL
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
/ .~ilding Inspector
Rev. 1/81
Location
Subdivision
N~me of Owner(s)
BUILDI~ DEP?d~T~NT
T0':~I OF SOUTHOLD, N. Y.
HOUSI~G CODE IHSPECTION REPORT
1200EASTMILLROAD MATTITUCK, N.Y.
tnu~Der ~ street) tl'iunlc~paii:y)
Map No. Lot(s)__
JAMES H. COBILL
Occupancy
A~mitted by:
A-I
JAMES H. COHILL
OWNER
{owner-~enan~)
Accompanied by:
Key available
Suffolk Co. Tax No. 107-1-2
Source of request
JA~S H. COHILL
_Date
APRIL 24, 1991
DWELL I ::G:
Type of construction WOOD ~
Foundation BRICK
Cellar
Total rooms, 1st. F1 3
Bar.broom(s) 2 ~o,.L
Porch, type FRONT ~ORCB Deck,
Breezeway Garage.
Type Heat., OIL 'Warm Air xx
Fireplace(s) NUEE No. Fz~its 2
Domestic hotwater YES .Type heater
Other PA~TRY FIRST FLOOR
PARTIAL
2nd. Fi 3
Toilet room(s)
typ~ Patio, type=
Utility room
.Hotwater
Airconditionin~
OIL
#sTories 2 STORY
Crawl space PARTIAL
3rd. F1
ACCESSORY STRUCTURES:
Garage, type const. 2 CAR WOOD FRA~EStorage, type const.
Swi,-~ning pool Guest, typ+e const.
Other
V~IOLAT!ONS:
--Location
.CHAPTER 45--N.¥. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
Description I-ATt-. I Sec.
.I
' Remarks: DEMO ~P~RMIT ~143~4, BP f14375Z-Co Z-14179 ISSUED FOR ADDITION
Inspected by: ~L .~' /~, Date of Insp. MAy 14, 1991
· ~ J./ FISH ' Time start9:40 end 10:00
t! <lt i,iRy - 31991
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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:
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.
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. Ac___curate surve of ro er showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed ~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.
Certificate of Occupancy on Pre-existin~Buildin~ - $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 Building...~/ ........... '
Location of Property .............. ~ .............
House No. Street Hamlet
Onwer ~ of Property ..... .~..~..~..~-..~...~. :...~?.~..~.~-. f-~ ...................................
County Tax Map No 1000, Section./.O. 7~.~.O. ..... Block..:.~./... ~d) .Lot...~..~..~....O..~..~...
Subdivision .................................... Filed Map ............ Lot ................. .....
............ Date Of Permit ........... Applicant .............................
Permit No ....
Health Dept. Approval .... Underwriters Approval ......
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ [~0 ' ~2¢~>
........ ...................
CONSENT
TO
INSPECTION
· the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) ~ the owner~ of the premises in the Town
of Southold located at
· which is shown and designated on the SuffoLk
County tax map as District 1000, Section[~7.00, Block ,0[0o , Loto~.,04~.
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
deem necessary xvith respect to the aforesaid application, includ£ng 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)