HomeMy WebLinkAboutZ-13355FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.t. .3.3.5.5. ......... Date ..... .~ .p.r.~. ~...1.5 .................. ,19 .8.5.
THIS CERTIFIES that the building ........ 0.9.% f.a. ,m.i.l.y., .dy.e. 1.1..~.n.~. .................
Location of Property 5~5 Birch .Ay.e, Southold
Hou~ '/V'd ..................
County Tax Map No. 1000 Section ...7.7 ........ Block ....2 ........... Lot .. J .5 .............
Subdivision .Goo~.a. Bay..Es ~,~te~ .......... Filed Map No. ] .1.7.6. ...Lot No..1.~/.1.3.~ ....
Requirements for a private one-family dwelling built prior to
conforms substantially to the
Certificate of Occupancy# 133
.... A. p .r.i. 1...2.3 ........ , 195, 7. pursuant to which ~hlg~{~3v~ ................. $ ....55
dated . 3~.r. $ J-..1.~, ................ 198. 5,., 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 .........
.... O~.e..~.~.~y, ~.~.e.~ ~ ~.g .....................................................
The certificate is issued to .... ELLA N C OKELE¥
................. ....................
of the aforesaid building.
Suffolk County Department of Health Approval ......... ~.o...r.e.c.o.~ d. ......................
No record
UNDERWRITERS CERTIFICATE NO ..................................................
Please
see attached inspection
report.
Rev. 1/81
BUILDID:G DEPARTi,~ENT
TO:'~r OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 585 BIRCH AVE.
[numoer & s~ree~)
Subdivision GOOSE BAY ESTATES
SOUTHOLD
(Municipality)
Map No.1176 Lot(s)132/138
N~me of Owner(s) ELLA M. COKELEY
Occupancy R-1
(type)
A~mitted by:
Key ~vailable
Unoccupied
(owner-~enan~)
Accompanied by: SAME
Suffolk Co. Tax No.
Source of request
JOAN M. MURRA~ ·
Date
77-2-16
4/8/85
D¥~LLING:
Type of construction Wood framed
Foundation Cement Block Cellar
Total rooms, let. F1 3 2nd. F1
Bathroom(s) 1
Porch, typ~ Deck, typ~
Breezeway Garage Under
Type Heat Oil fired Warm Air
Fireplace(s) 1 No. ~its
Domestic hotwater Yes
Other
Full
#stories 1
Crawl space
3rd. F1
Toilet room(s)
Patio, typ~__
Utility room
Hotwater xx
Rirconditioning
Type heater .Tankless
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS: Housing Code, Chapter 52
.Location
Descriotion
No violations whgre found.
See.
Remarks:
Inspected by: ~,~?_~ ~/~~Date of Insp. 4/12/8~
Curtis W. Horton 'Time startl2:15 end
12:45
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
BLDG. DEP;'
TOWN o~ SO,',J~ ?____
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 p=operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
, ~,.J~ate..~.¢ . F .,..~'~-......
Location of Property .~..~..... ~. ~-'~. ~ ........ ~//~'//X.~.. · .~4~'~/. · .~. ~ .....
Owner or Owners of Property ..~_...__ ............
Subdivision__~. ~,_ ~. ,~County Tax Map No. 1000 Section~. ~ ~ .... .~..~7~... :~BIock .... Filed Map No. ~.~.. ~..~....Lot No. ..... ~ ...... l°t ' ' '/' .~. ~.~.~.' i i ..
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ...... ~. ................. Planning Board Approval ......-7~..>~ ...........
Request for Temporary Certificate ..................... Final Certificate ....................... ~
Fee Submitted $ f.I..~"~.~_/..// ....................
Rev. 10-10-78
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ,~*~¢¢,/.. .~4.¢?../.¢-¢...
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
· the undersigned·
That the undersigned (is) (are) the owner~r 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 7 · Block ~ , Lot / ~
That the undersigned (has) (have) filed, or caused to be filed, an applica-
tion in the Southotd 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 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 ba 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.
gnature)
(print name)
(signature)
(print name)