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Home My WebLink AboutZ-20656FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-20656 Date APRIL 17~ 1992 THIS CERTIFIES that the building ONE FAMILY DW~3J.ING Location of Property 2595 WESTPHALIA ROAD MATTITUCKr N.Y. House No. Street County Tax Map No. 1000 Section 114 Block 10 Lot 22 Subdivision Filed Map No. Lot No. Hamlet conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9~ 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-20656 dated APRIL 17r 1992 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 * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTAC~ED INSPECTION REPORT. BENJAMIN COXt DECEASED Rev. 1/81 N/A / 'Building Inspector Location BUiLD!fiG DE?:'J, Ti. LEiiT TO'J[ OF SOUTHOLD, if. Y. HOUSIXC CODE IDSFECTIO~,~ RE?CRT 2595 WESTPHALIA ROAD MATTITUCK, N.Y. Subdivision Nm'ne of Owner(s) BENJAMIN R. COX, DECEASED Occupancy A~mitted by: A-I Res. (type) JAMES COX Key available Source of request JAMES R. OWNER Accompanied by: SAME Suffolk Co. COX Ta:~ No. Date 114-10-22 APRIL 15, 1992 ~'~LLI~: ,Type of construction Foundation CEMENT BLOCK Total rooms, 1st. F1 Bathroom(s) 1 FULL BATH Porch, t~rpe Breezeway Type Heat OIL Fireplace(s) NONE Domestic hotwater Other WOOD FRAME ~, torles ONE __Cellar FULL Crawl space 2nd. Fi_ ~Srd. ~1 ~eck, Garage 'Warm Air No. ~cits YES Toilet room(s)_ type. REAR Patio, 1 CAR Utility room XX Hotwater type 2 ~Ype heater LILCO GAS ACCESSORY ~ouc~,~u . Garage, type const. Swim. ming pool Other NONE Storage, type const. Guest, type const. V~0LATIoNS: ~Lncation Remarks: Inspected by: .CIIAPTER 45--N.Y. STATE UNIFOI~! FIRE PREVENTION & BUILDING CODE D-~c~,.zon Art.[ Sec. BUILDING PERMIT {12627-Z - CO Z-15254 ~ ' Date of Insp. APRIL 17, 1992 GA~/~F. FIS~ 'Time start 9:40 end I0:00 Form No. 6 TO,TN OF SOUTIIOLD BUILDING DEPARTMENT TOWN IL~LL 765-1802 BLDG. TOWN OF SOUT~OLO 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 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-exlst%ng land uses: 1. Accurate survey of property showing all property lines, Streets, building and unusual natural or topographic features. 2. A ~roperly 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 i. 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 Building - $100.00 3.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_~, ~mmercial $15.00 , .... ............. New Construction ........... Old Or Pr~-ex~g Bui~d,~g....~[[.,~ ..... House No.' Street Hamlet ...... Onwer or Owners of Property County Tax Map No 1000, Section .... ~/.~: ..... Block ..... /~ ........ Lot.....~... ............. Subdivision ............... .......... · .......... Filed Map ............ Lot ...................... Permit . ... Health No ................ Date Of Permit ............... Applicant....~ ............. Dept. Approval ......................... Uaderwriters Approval.Y~.~..~....i Planning Board Approval ..................... Request for: Temporary Certificate ........... Final Ccrticate ........... Fee Submitted $ ............. .................... .... do(es) hereby state: CONSEt;T TO INS PIEC'FION Name(:D m.o , TOWN OF.SOUT~O{~ ' the tmdcrsigncd, That the undersigned (is) (are) the OWner(s) of thc premiser; in thc Torah -- which is shown and des[r'nated on the Suffolk County tax map as District 100O, Section_// L/ , I31ock / O That the undersigned (has) (have) filed, or caused to be filed, an app}ica- tion in the Southcld Town ]Euilding Inspector.s Office for the followin.~: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of $outhold to enter upon the above described property, iucluding an3' and all buildings located thereon, to conduct such inspections as they may dee-'~n necessary with respect to the aforesaid application, inc!udin% !nspeclions to determine that said premises comply with all of thc laws; ordinances, rules and re,~ulations of the Town cf Southold. The undersigned, in consenting to such inspections, do(es) so t%ith the knowledge and understanding that any information obtained in tile conduct of such inspections may be used as evidence in subsequent Prosecutions for lation$ of the laws, ordinances, rules or regulations of the Town of Southold. ~%._J -' (signature) (priut name) (s itjnatur.c) (pmnt name) / / / / / / / / / / / / / / //