HomeMy WebLinkAboutZ-22917FORM NO. 4
TOWN OF SOUTHOLD
BUILDING EEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCcupANCY
No Z--22917 Date MARCH 24, 1994
THIS CERTIFIES that the building. ONE FAMILY DWELLING
Location of Propert~ 1615 PIKE STREET MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 140 Block 2 Lot 45.1
Subdivision Filed Map l~o. 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-22917 dated ~RCH 24, 1994
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 OWE FAMILY DWELLING WITH ACCESSORY 2-1/2 CAR GAR~E *
The certificate is issued to WALTER L. DOHM
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION MEPORT.
N/A
N/&
N/A
Building Inspector'
Rev. 1/81
LOCATION:
SUBDIVISION
NAME OF OWNER (s)
EUILDING DEPAR~NT
TOWN OF SOUR[OLD
HOUSING CODE INSPECTION REPORT
1615 PIKE STREET
(number ~ strc~
MAI' NO.
MATTITUCK, NEW YORI(
(,,u n i c i p~----~ 1 i [ y
tOT
OCCUPANCY
(type)
ADMIi~gD BY:
KEY AVAILABLE
SOUKC2 OF REQUEST:
SINGLE FAMILY DWELLING
WALTER DOI~4
SAME
ACCO~IPANIED I~Y:
SUFF. CO. TAX MA~ NO. 1000-140-2-45.
DATE: MARCH 16, 1994
DI~I,LING:
1YFE OF CONSTRUCTION WOOD FRAME
FOUNDATION POURED CONCRETE & CEMENT BLOCK
TOTAL ROOMS: IST FLR. '5 2ND FLR.
BATHROOM (s) 2 TOILET ROOM (s)
PORCII TYPE REAR COVERED DECK, TYPE
BREEZEWAY FIREP~\CE
DO}~STIC HO~4ATER YES TYPE HEATER
TYPE ~AT GAS-LILCO WARM AIR
O~IER:
2
g STORIES
CELLAR F1]LL
3 3RD FLR.
I
3
EXITS
- CRAWL SPACE
UTILITY ROOM
· PATIO· TYPE
NO GARAGE
LILCO GAS
AIRCONDITIONING
HO~ATER XX
ACCESSORY STRUCTURES:
C,%tG~GE, TY?E OF CONST.
SWI~?IINC POOL
OTIIER:
2-1/2 CAR WOOD FRAME
STORAGE, TYPE CONST.
· GUEST, TYPE CONST.
VIOI.\TIONS: CI1APTER 45 N.Y. STATE L~IFORM FIRE PREVENTION & BUILDING CODE
LOCATION I DESCRIPTION ,~R.T. SEC.
REHARKS:
INSPECTED BY:
DATE ON INSPECTION MARCH 18, 1994
TIME START 9:40AM END 10:00 AM
Form No. 6
TO~N OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
A~PLICATION 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.
6. Submit Planning Board Approval of completed site plan requirements.
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 Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ..... !~-~m-.. [ .~-..~.[ ~.? ~ ..................
New Construction ........... Old Or Pre-existing Building....~. ........... ~
Location of Property.. .................. ..... .~.k~%.~. %~.~+~ ............
House No. Street r, Hamlet
Onwcr or Owners of Property ..... ~].c%.~..er.~....~...~'~ .~....-r~..~.~ ............................
County Tax Map No 1000, Section .............. Block ................ Lot ......................
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate ...........
Eee Submitted: $ ............................. ~ ~,~
CONSENT
TO
St EC FI )N
Ot~mer(s; Name(s)
do(c,s) hereby state:
· the undersigned,
That the undersignc, d (is) (ape) the owner(s) of tbe premises in the Tovrn
? -- /'3 /
· 't ' : i: :hewn and des[Enated on the Suffolk
County tax map as District 1000, Section ) , Block 2~ , Lot ~/~ , {.
Tha~ the undersigned (has) (have) filed, or caused to be filed, an applica-
tion in the Southold Tox~m Buildin~ Inspector's Office for the following:
C
That the undersigned do(cs) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, including
any aud 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 ~f Southold.
The undersigned, in consenting to such fmspeetions, do(es) so with the
knowledge and understandiug that any information obtained in the conduct of
such inspections may be used as evidence in subsequent prosecutions for
lations of the laws, ordinances, rules or regulations of the Town of Southold.
/ (signature)
(print name)
(sifnature)
(print name)