HomeMy WebLinkAboutZ-18161FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-18161 Date JULY 3~ 1989
THIS CERTIFIES that the buildings ONE FAMILY DW~-?~.TNG
Location of Property 21605 MAIN ROAD
House No.
CUTCHOGUE~ N.Y.
Street Hamlet
County Tax Map No. 1000 Section 108 Block 3 Lot 11
Subdivision Filed Map No. Lot No.
conforms substantially to the requirements for a private one-family
dwelling built prior to: APRIL 9~ 1957
pursuant to which
CERTIFICATE OF OCC. #Z-18161 dated JULY 3~ 1989
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 DWF~J.INGWITH ACCESSORY ONE CAR WOOD GARAGE &
ACCESSORY WOOD STOI~GE BUILDING. *
The certificate is issued to
of the aforesaid building.
DORIS CYBULSKI
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NO RECO~D PRE-EXISTING
UNDERWRITERS CERTIFICATE NO. NO RECORD PRE-EXISTING
PLUMBERS CERTIFICATION DATEDNO RECORD PRE-EXISTING
*PLEASE SEE ATTACHED INSPECTION REPORT.
NOTE: THIS DWELLING IS NON-HABITABLE UNTIL MAJOR REPAIRS ARE COMPLETED.
Rev. 1/81
BU~DI:',G DEPARTi'~DT
T0','~I OF SOUT,0LD, N. Y.
Location
Subdivision
N~me of Owner(s)
HOU~I,G CODE IHSPECTION REPORT
21605 MAIN ROAD CUTCHOGUE, NEb; YORK
~nua,~er ~ s~ree~) ~£dun~cipa±i~y)
Ma~ No. Lot(s)
DORIS CYBULSKI
Occupancy R- l
(~ype)
A~i~,ted b~: MRS. CYBULSK. I
UNOCCUPIED
(own er-~enan~
-Ac~;ompanied b~: SAME
Key available
Suffolk Co. Tax No.
Source of request.
DORIS CBULSKI
Date
108-3-11
6/14/1989
D~.'~LL IMG:
Type of construction WOOD PP~D
Foundatfon Cl~l~ff~ BLOCK
Total rooms, 1st. Fi
Bathroom(s) i
Porch, type
BreezewaL
Type Heat NONE
Fireplace(s)
Domestic hotwater
Other
#~tories 1~
CellarPA~T L~L Crawl space.
3 2nd. F1 I 3rd. F1
Toilet room(s)
Deck, type. Patio, type
Garage Utility room !
Warm Air Hotwater
No. F~cits ! Airconditionin~
YES Type heat'er GAS
~CCESSORY STRUCTUREs:
Garage, type const.~OOD O~E CAR Storage, type const.
Swi,~ming pool Guest, type const.
Other ACCESSORY STRUCTURES AREBEYONDREPAiR
_Location
OUTSIDE
INSIDE
CELLAR
V~IOLATIONS: CBAPTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
De .... Dtzon
front porch rotten, ~indo~s broken, cellar
entrance bad. The entire outside ts tn need of
ma.lot repaxrs.
Sec.
Is very bad holes in the walls, floor, ceiling,
bathroom terrlble, needs major work.
Some floor joists rotten, wiring terrible, no he*.
Cb. %5, N.Y.S. Unifor~ Fire Prevention 1242.!
1242.9-1243.7-1243.8-1244.1- 1241-CH F.
Remarks. THIS D~/ELLING IS NON-HABI"TABLE I~TIL NAJOR REpAIR_~ ARE COHPLETED.
CURTIS
Da. re of Insp. JUNE 21, 1989
· Time start 10:00 end 11:00
TOWN OF SOUTHOLD
BUILDING DEPARTHENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING...~..VACANT LAND
Locat£on of Property .... ~..,~,.,.,.~.~.~...~., .....
Owner or Owners of Property.. ~'...
County Tax Map No. 1000 Section ./0.0. Block .~ .... Lot .A~ .....
Subdivision ....................... Filed Map ........ Lot ..........
Permit No ........... Date of Permit .......... Applicant ...................
Health Dept. Approval .................. Underwriters Approval ..............
Planning Board Approval ................
Request for Temporary Certificate ....... Final Certificate ................
Fee Submitted: $-.~O~.,.Z.0. .........
APPLICANT. . .
CONSENT
TO
INSPECTION
Ox~mer (s) Na{ne(s)
do(es) hereby state:
· the undersigned,
Thai the undersigned (is) (are) thy~_owger(s) of~the~premis,~s inJ~
~a~C~Dm/l~, , which is shoxm and designated on the Suffolk
County tax map as District 1000, Section /0~ · Block ~ , Lot //
ThaL 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 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 lhe laws· ordinances, rules or regulations of the Town of Southold.
(print flame)
(signature)
(print name)
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