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Home My WebLink AboutZ-22281FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22281 Date APRIL 28~ 1993 THIS CERTIFIES that the buildinR Location of Property 3655 BAY SHORE ROAD House No. Street County Tax Map No. 1000 Section 53 Block 6 Subdivision Filed Map No. ONE FAMILY DWELLING GRRKNPORT~ N.Y. Hamlet Lot 15 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-22281 dated APRIL 28~ 1993 was issued, and conforms to ali of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DW]~3I.INGWITEACCESSORY ONE CAR GARAGE * 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 FRANK & GLADYS CSAJKO N/A N/A /~ Bu{lding Inspector LOCATION: BUILDING DEPARTHENT TONN OF SOU~tOLD DOUSING CODE INSPECTION REPORT 3655 BAYSHORE ROAD GREENPORT, N.Y. SUBDIVISION (number & street) NAME OF OlaqER (s) MAP NO. (municipality LOT (s) FRANK & GLADYS CSAJKO OWNgR OCCUPANCY A-I RES. (type) (owuer-tenant) ADMI'I-i-gD BY: FRANK CZAJgO KEY AVAILABLE SOURCE OF REQUEST: GLADYS C. CSAJKO ACCOIdPANiED BY: SAME SUPF. CO. TAX MAP NO. 53-6-15 DATE: APRIL 12m 1993 DWELLING: TYPE OF CONSTRUCTION FOUNDATION TOTAL ROOMS: IST FLR. BATHROOM (s) ONE PORCH TYPE BREEZEWAY DOMESTIC HOT~ATER TYPE NEAT OIL ffl'Hl~R: ~,~3OD FRA~ CEHENT BLOCK YES W-a,J~l( IN GLOSKT 2ND PLR. TOILET ROOM (s) ONE DECK, ~E FINEPLACE ONE TYPE NEATER OFFBOILER WARM AIR · ~ STORIES ONE t EXITS TWO CELLAR ClIAWL SPACE XX 3RD FLR. UTILITY ROOM PATIO, TIlE GARAGE AIRCONDITIONING HOTWATER H ACCESSORY STRUC'ruggS: GARAGE, IYFE OF CONST. SWII~IING POOL OTHER: ONE CAR WOOD FRANE STORAGE, TYFE CONST. · GUEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. INSPECTED BY: DATE ON INSPECTION APRIL 19, 1993 TIME. START 9:20 END 9:35 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN NALL 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. Submit Planning Board Approval of completed site plan requirements. ...... III 1111 _ I. I. [11. -, ,,,, ,L ........ III 111' -I~ ~1 .... _ I II II I Illl ii _ _ I~'.~'' ~, ~ ~ 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 Building - $i00.00 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, Commercial $15.00 Location of Prope;t;J]i.ij .: ...... .~.~...~..~..~,r~ .~,,~. ...... ttouse No. Street Hamlet Onwer or Owners of Property .................. ~.~... County Tax Map No lO00, Section ..... ~.~ .... Block .......... ~. .... Lot ...... ~.~.C .......... Subdivision ............................... -- .. · Filed Map ............ Lot ................... .. . Permit No ................ Date Of Permit .............. .. Applicant ....................... .... .. Health Dept. Approval .................... · -- · · ~Underwriters Approval ....................... .. Planning Board Approval ....................... . Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................ ~ · · ........... cONSENT TO INSPECTION i)x~er(s) Name(s) do(es) hereby state: · the undersigned, That the undersigned (is) (are) the owner(s) 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~, Block ~ . Lot .~ That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southo]d 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 inspect, ions as they may deem necessary ~vith 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 6f Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained [n 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: ( p~"in t name) (signature) (print name)