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Home My WebLink AboutZ-24863FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCupANCY No Z-24863 Date JANUARY 28, 1997 THIS CERTIFIES that the building Location of Property 2255 ~RaND AVE. House No. County Tax Map No. 1000 Section 10T Subdivision ONE FAMILY DWELLIN~ Street Block 8 Lot 3 Filed Map No. Lot No. MATTITUCK~ N.Y. 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-24863 dated JANUARY 28, 1997 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 F~TT.Y DWELLINO WITH GARAGE ~DER HOUSE & ACCESSORY HTORAGE SRED * The certificate is issued to of the aforesaid building. ~Tl.l# DIcI~sRSON (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *pLEASE SEE ATTACHED INSPECTION REPORT. N/A N/X ~/B~ld~i~n~inspector Rev. 1/81 BU I I.I) 114(; I)I~,I:'AI{THI~,NT TO~/N (}1~ S011'1'1101,1) IIOU,~ ! N(~ COI)R I.N,qPE(~:'F ION REI~OR'F I.OE^'I'ION: 2255 GRAND AVE. SHITI) I V ] ~ 1 (}N ............................ FlAP NO._ NAHI~ Of ONNER (~) ~ DTC~RSO~ OCCUPAN(:Y A- I RES. O~R ~L~ DIC~RSON ACCOHPANTI~I) BY: S~ AI)HIT'I'EI) BY: ...................... KEY AVAII.ABI.E ~'~'~AX HAP NO. IO00-107-8-8 S(}UECE O1~ EE(~UES'I': ..... ~ C. DZC~RSON DATE: J~- 15, 1997 'l:~Pl~ O~"~ONSTRUCTION ~D F~ ~ S'I'OITTES ] ~ EXITS 3 I:OUNI)A'FION ~ B~K CI~I.I,AR 75~ CEA~I, ,qPACE 25~ TOTAl, R(}OHS~ IST FI.R. 7 2NI) FI,R. I~A'I'IIEOOH (s) ~ F~L TOIl,ET EO0~i (~) O~ UTII.ITY POItCII TYPE gECK, TYPE ~ ~D PATIO ~D A~ ~L I~EEEZE~AY FIEEPLACE O~ .......... (:AEA(;E 2 CAR ~A~ ~ER HOUSE I)OF1RST1. C IIO'~ATEE . ~S .__ TYPE II~ATEIT _ OT~ ........ AIECONI}~TTONIN~ TYI~E IIEAT OIL & PARTZ~ ELEC ~AEH AII~ ~ IIO'I~ATEE O'I'IIEI~: CO~D FRO~ E~Y ~AY ACCESSOEY S'I'EUCTUEES: (,AEA{,I,, TYPE OF CONST. S~IHNING POOl. , (;UES'F, TYPE CONS'I'. OTI[ E R: LOCATION I)ESCR[I"I'LOH ART. SEC. iHt, HARKS: BP ~2055Z-gOZ-2145-(l~ell) BO ~5922Z-COZ-7470 (Add) BP ~9253Z-COZ8916 (Pool/Fence) BP ~9661-Z' COZ-9179-(Accy Bldg), BP #I2106Z-COZ-11931-Z (Add) BP ~23897-Z-COZ-24863 INSPF. CI'ED BY ------ ----CA/RY/O'.,/FTSH 'riH[~. s'r^P,T 9:/+5 ~ Em) I0:15 AN Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMEnt TOWN IIALL 765-1802 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. ~. Submit Planning Board Approval of completed site plan requirements. B. {For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly 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 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 Buildinm - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .. J. aouar.y..15,. 2.~97 .................... New Construction ........... Old Or Pre-existing Building...~ ............ Location of Property...~$~. ............ .G~o¢.Av.~.n%~D .............. ~g~i~Qk .............. House No. Street Ham-let Onwer or Owners of Property; .... A~I,~. C,. ~iGk~gOp. ~d.Ch~.~lott~ nicke=r:s~m ............ County Tax Map No 1000, Section...~Q7 ........ Block....~ ........... Lot .... 3 ................. Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval.' ......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: .Temporary Certificate..ii .... Fin~erticate..~ ....... C0~ S ~S 6¢ Allan C. Dickerson CONSENT TO INSPECTION AT.r,A~ C_. DICKE%$Q~ ' , the undersigned, Owner(:~) Name(9) do(es) hereby state: one of That the undersigned (is)/C~"~k the owner(s) of the premises in the Town of Southold located at 2255 Grand Avenue~ Mattituckt New York · which is shoxvn and designated on the Suffolk County tax map as District 1000, Section 107 , Block 8 , Lot 3 That the undersigned (has) ~ filed· or caused to be filed· an applica- tion in the Sou/hold Town Building Inspector's Office for the following: Certificate of Occupancy pn Pre-existin9 Building 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 the laws, ordinances, rules or regul%~ons of the Town of Southold. ~-'~-- Allan C. Dickerson (print name) (signature) (print name) O! nov~ ~. ooOCU FF I(, ol*et't ~' NOTES I. SUFFOLK COUNTY TAX MAP DIST. IO00 SEC~ 107 BLK. 8 LOT 3 2. B:MONUMENT Bio~es~,i ~UIWEY FOR ALLAN C. DICKERSON & CHARLOTTE DICKERSON AT MATTITUCK DATE: MAY TOWN OF SOUTHOLD SCALE: ~"=40' ~UF~ ~TY, NEW ~ ~o. i~u~lzEe aLt~tt~ O~O~TION ~ ~IS GUARANTEED TO: ~RVEY m a V~A~ ~S~Ct~Oa 7ZOI ~ THE ALLAN C. DI~N~~~ ~ ~ STATE E~ATI~ LAW I C~l[I ~ mil ~VEV KT ~S THE LANO CHARLOtte'S' ~ ~RVE~'S I~D ~L OR EMI~SEO G SHALL SUFFOLK~O~~ANK YOUNG · YOUNG ~OEN W.~G,P~FE~I~AL ENGINEER N~ ~ ~O ~0 ~VE~R N.Y~. UCENSE ~. t