HomeMy WebLinkAboutZ-15311FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z-15311
Date March 2, 1987
THIS CERTIFIES that tbe build~g ONE FAMILY DWELLING
Location of Property 4100 Youngs Avenue Southold, New York
I~l~s~ Ho: ........................................................ Street Ham/et
55 2 14
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision ............................... Filed Map No ......... Lot No ..............
Requirements for a private one-family dwelling built prior to
conforms substantially to the ~ - :~l~lx~sctlfle~lll~8#tre~c
CERTIFICATE OF OCCUPANCY
April 23, ~957 Z-]531l
...................... pursuant to which ~~txNo ......................
dated March 2, 1987 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 AND ACCESSORY SHED.
The certificate is issued to PARKER E. & BETSY B. DICKERSON
..................... x x ...................
of the aforesaid building.
Suffolk County Department of Health Approval No record - Pre existing
UNDERWRITERS CERTIFICATE NO. N o r e c o r d - P r e e x i s t i n g
PLUMBERS CERTIFICATION DATED: N/A
*Please
see attached
inspection report
Rev. 1/81
BUILDIMG DEPARTI,[ENT
T0%'~N OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 4100 Youngs Avenue,
(number & streeT)
Subdivision
$outhold, New York
(Municipality)
Map No. Lot(s)
Name of Owner(s) Parker E. & Betsy B. Dickerson
Occupancy
Admitted by:
R-]
(type)
Parker Dickerson
Key available
Tenant
(owner- tenant )
Accompanied by: SAME
Suffolk Co. Tax No. 55-2-]4
Source of request Parker Dickerson
Date
2/26/1987
Wood framed
5
.~stories 1-1/2
Cellar Partial Crawl space., rest
2nd. F1 ] 3rd. F1
Toilet room(s)
wood Patio, type.__
Utility room
Hotwater x
Airconditioning
Solar
D~fELLIMG:
Type of construction
Foundation Cement Block
Total rooms, 1st. F1
Bathroom (s) 2
Porch, type glassed in Deck, type.
Breezeway Garage
Type Heat Oil fired Warm Air
Fireplace(s). No. F~xits
Domestic hotwater yes
Other Finished room in cellar
.Type heat'er
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
NONE
Storage, type const.
Guest, type const.
VIOLATIONS:
Location
REAR STEPS -
CELLAR -
Housing Code, Chapter 45 N.Y. Stat¢~ifo~m~Fire Prevention
& BUlAGlnG coGe
Description t-Art. I Sec.
Being repaired
No rail cellar stairs
BUILDING PERMIT ]2245Z HAS EXPIRED, IT WAS NEVER
USED.
Remarks: Dwelling has smoke detectors
Inspected by: (~'~ ~, ~/~ Da. re of Insp. 3/2/1987
Curtis W. Horton 'Time start 9:00 end 9:30
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Thi~.application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the follo~ving; for new buildings or new use:
1. Final survey of property with accurate location of ell buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposel-(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 end 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all pro[oerty 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.
Fees:
1 Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
landuse--Pre-Existing C.O. $15.00
Vacant, land C.O. $ 5.00
Date... ................... · · · ·
New Building ............. Old or Pre-existing Building .... /~. ...... Vacant Land .............
Location of Property....//~'..~.rJ. ....... .~-,-~.. ~/'~4/.~ ~ ................ ~~.~:Z;,;
Hou~ No. ~ / ~ ~tr~t ~mm=
Owner or O~ner~of ~ro~e~ .. tv ~v ........ .]. ............
/4 ......
Coun ax Map No. 1000 Section Block Lot .......
Subdivision ............. Filed Map ~o ........... kot ~o ..............
Permit ~o ........... ~ate of ~ormit .......... ~p~licant .................................
Health Dept Approval Labor Dept Approval ...........
Underwriters Approval ........................ Planning Board Approval ......................
Request for Tempora~ Certificate Final Certificate ~. .............
Fee Submitted $.. .................... .. · ... ·
Construction on above described building a~,~ermit meets atl~a~licable codes and regulations.
Applicant_ .~~..~.'..~. .~.' - · · · .~~. · ...................
Re~. 10-10-78
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
· the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
/, ,
· which is shown and designated on the Suffolk
County tax map as District 1000, Section ~-J- , Block 2. , Lot /5/
That 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 xvith all of the laws. ordinances, rules
and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so ~vith 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 regulations of the Town of Southold.
(signature)
(print name)
(signature)
(print name)
STATE OF NEW YORK )
) SS.:
COUNTY OF SUFFOLK )
PARKER E. DICKERSON, being duly sworn, deposes and says that he
resides at 1485 Mill Creek Drive, Southold, N.Y., and that he has been
a resident of Southold Town for the past ~l years;
THAT he and his wife, Betsy B. Dickerson, own that certain property
known as 4100 Youngs Avenue, Southold, New York and designated on the
Suffolk County Tax Map as: Dist. 1000, Sec. 55, Block 2, Lot 14. A
copy of a survey of these premises and more, dated October 30, 1957,
prepared by Otto W. Van Tuyl & Son, Licensed Land Surveyors is
attached hereto.
THAT on personal knowledge, information and belief, vour deponent can
on
as well as storag~ shed not snown survey,
state that the structures shown on said survey/were built prior to
April 23, 1957; that there have be.en no changes to said structures,
other than normax maxncenance,~since prior to April 23, 1957.
Dated: 2/ /87
SworD~o before me this
a of E r ry, 1987.
~- N'o~r y 'Publi~
Parker E. Dickerson