HomeMy WebLinkAboutZ-19378FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-19378 Date SEPTEMBER 24r 1990
THIS CERTIFIES that the building. QNE FAMILY DWELLING
Location of Property 155 PINE ROAD SODTHOLDr N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 54 Block 9 Lot I9.1
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-19378 dated SEPTEMBER 24r 1990
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 DW~.LLINGNTTH ATTACHED 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 ATTACfIED INSPECTION REPORT.
//
ESTATE OF RONALD B. DIT.nF3~BEC~
~uilding Inspector
Rev. 1/81
BUI~DI..G DEP.~J{T:LENT
TO:'~! OF SOUTHOLD, N. ¥.
Location
Subdivision
HOUSING CODE IHSPECTION REPORT
155 Pine Road-' Southold, N.Y.
~numoer ~ s~ree~) (l,iunzc£pa±i~y)
blap No. Lot(s)
Ne~me of Owner(s) ESTATE OF RONALD B. DILLEIqBECK
Occupancy. A-I
(type)
A~mitted by: SELF
(owner-~enan~)
Accompanied by: SELF
Key available
Suffolk Co. Tax No. 54-9-]9. I
Source of request
GARY FLANNER 0[SEN, A'l-r¥
Date
9/12/90
DZ'~LLIMG:
Type of construction wood FRAME
Foundation CEMENT BLOCK Cellar PARTIAL
Total rooms, 1st. F1 ? 2nd. Fl. - -
#stories ONE
PARTIAL
Crawl space
3rd. F1
Bat~hroom(s) 2 FULL
Porch, ~ype FRONT EIqCLOSED Deck, type.
Breezeway. Garage. I CAR
Type Heat OIL & ELEC. 'Warm Air xx
Fireplace(s). O~E No.
Domestic hotwater ELECTRIC
Other
Toilet room(s) - -
Patio,
Utility room
.Hot~ater
Fzcits 2 Airconditioning
.Type heater NATIONALE LINE
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
RO~E
Storage, type const.
Guest, type const.
VIOLATIONS:
_Location
.C~APTER 45--N.¥. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
Descriotion Sec.
.{
· Remarks: B.P. t[4318-Z CO #Z-3679 FOR ADD & ALT.
'Time start 11:5o end
12:15
FORM NO. 6
TOWN OF SOUTHOLD
· Building Depa,b,~ent
.' Town Hail · .
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
~ "Instructions
A. This application must be titled in typewriter OR ink, and SUbmitted i ~ to the Building
tot wiAh the following; for new buildings or new use:
1. Final survey of property with accurate location of all bu{tdings, property lines, streets, and unusual
natural or topographic features. · ~ ' ~ ' .
2. Final approval of Heal.th Dept. of water SUpply and sewerage dtsposel-(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 and Installa-
lions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site p~an raquiramente where applicable. ~ '
B..For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "preexisting"
land uses: ·
1. Accurate survey of property showing all property lines, streets, buildings and unuSUal natural or
topographic features. ·. . ..
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 bu Id~ngs or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $25~00 -- BtlS[NESS $50.00
2. Certificate of occupancy on pre-existing dwelling $ 5 (] .. OO
3. Copy of certificate of occupancy $ $;'O0, 0vet .5 yeats $10.00
4.Vacant Land C.O. $ 20.00 September 12, 1990
5.Updated C.O. $"50.00 ~. Date ................... ~.~ ....
NewCone I~t-uc t;ion ...... Old or Pre-existing Building ........ Vacant Land ......... %<, ·
Location of Property ...~55. P.L~. j~.o~,.. 5pp~hP.~d.. NY .....................................
. House No. Street Hamlet
Owner or Owners of Property ..................................
~.4 .... Block ~ Lot 19 1
County Tax Map No. 1000 Section ....................................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health D'ept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........... ~ .Planning Board A~proval .....
Fee Submitted $ ........................... ~.~ - .
Construction on above described building and per 'm/~/~~pl,cab/le codes and regulations.
A licant . . . ~.~.~.~ ...............................
PP ~ary Fla~~ Olse~,' ~sq. .
R~.10o10-78 P.O. BOX 706
Cutchogue, NY l]935
CONSENT
TO
INSPECTION
Owner(s) Nar~e(s)
do(es) hereby state:
That the undersigned (is) (~r=) the o~ner(s) of the premises in the Toxin
· which is shown and designated on the Suffolk
County tax map as District ~000, Section ~ . ~loek 0~ ,Lot \~ ,%.
That the unders~ned (has) (have) filed, Or caused to be filed· au applica-
tion in~ Southold To~ ~ullGing lnspuu~ .~ or{~.. ~.. +~ Follow.g:
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 subsequ/~rosecutions for vio-
o. or
~. ~ , ' /~gnature)
(print name)
(s i~natu re)
(print name)