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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRS E%ISTING
CERTIFICATE OF OCCDPANCY
No Z-24014 Date NOVEMBER 3, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 460 BAY AVENDE EAST MARION, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 31 Block 8 Lot 8
Subdivision Filed Map No. Lot No.
conforma substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-24014 dated NOVEMBER 3, 1995
was issued, and conforma to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ACCESSORY SHED
The certificate is issued to JOSEPH DZENROWSRI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT. A
B lding Inspector
Rev. 1/81
INI I LU 1111: I11C 1'AKTHIitfl'
` ~ 'f(IWtI OI+ SlllTl'1101.0
IIOIISINC (,0111'. It151'C(:'1'IOtI Rf•.I'UICI'
LOCA'1'IOt7; 460 SAY AVE. EAST MARION, N.Y.
number 6 strr.c(j-J--_- f~unuilcipnlity~~--~
sunulvtsloN rlnr No. Lo'r(s)
NAMI~. lIP ONt11C 14 JOSEPH DZENROWSRI _
llfflll'ANCy SINGLE FAMILY
ZfYpcj------'------~-------J~ouncr'Lennu(~-------- _ -
A11rI I'I"1'I(U 11Y: LINDA LEE SPANGEI. ACC.OtII'AIJ 11?.II IIY: SANE
K F:Y AVAILAIIi.I'. `;Uli~i.(;O. TAX F1A1' IJO- 1000_31-8_8
SOIIRCIi 4P REg11I'.S'!': AILLIAM PRICE, ATTY UA'I'1!:_ OCT._27,_1995-____
UNIT LI,I NG:
'fYI'P, OP CONS'[7tOCTI(}r( WOOD PRAMS 1 STOItICS 2 / IiXil"S
f OIINNA'I'Ipy CEMENT ~ CF,LLA{t FULL CRAWL SI'ACP.
'I'O'TA I. Nl10rl;i: _--I S'f PLR. - 2NU FLIt._ 3 '3RU PI,R.
IIA"I'lIRUOrI (s) ONE J 7'01Id3T It0(IFt (s) _ ul'7LI'Tr KooN REAR MUD ROOM_
I'URCII '1'YPI? SIDE SCREENED IIIiCK, 'I'Y 1'E ~ PA1'10
I)FtItP.'LIiWAy I' l1(LI'LACB C.Alt Alai
UGHI?S'1'IC 110'1lJA'i'gl( RR--_.- '1'YI'r: III~.A'fBlt LILCO GAS A[1tCUNU I.'PIONING J___"-__.J_-_"---
'1'Yl'C IIIi A'I' LILCO GAS NARH Allt BR I10'1'WA'llal
-----T----------
o7urR: KITCHEN PANTY
ACCESSORY 5'1'R11(:'1'111tIiS:
OARACE, '1'Y 1'E OP CONS'1', S'1'OI(AGIi, 'CYPP. CONS"f. OLD STORAGE SRED
SNIHFIINC POOL-- (:IIES'I', '1'YPI•; CONS')'--- --J---_
O'1'Illi lt:
V101.A'['1111J5: CIIAI'TEI( 45 N.Y. '.i'1'A'1'E IINIPOIt FI Pllt li l'REVEN'I'lON 6 II1111.UING COllli
L(ICA'1'IOtI -_UES(:RIL''['1pN _ AR'f, SIiC_
Rrtlnltr„: _ SOME AREAS DETERIORATED
rn!:Pr•,C'fhn nY JOHN M. BOUFIS onl'r•, oP nJSt'EC°T)(>N NOV_2, 1995
"_"-`_"-J--~ '1'INIi S~1'All'I' 9:115 IiNll IO: 15
/ 1/.-
A~/~ n
CVllp l\V. V -
TONN OF SOUTILOLD
BUILDING DEPARThIENT _ _
TOWN l1ALL I ~ ~ ~,Q~~
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 Che following: for new building oz new use:
1. Final survey of property with accuratn location of all buildings, property lines,
streets, and unusual natural or topographic featurea.
2. Final Approval from Health Dept.~oE water supply and sewerage-disposal(S-9 focm).
3. Approval of electrical installation Erom Hoard of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
•t. less than 2/10 of 1~ lead. •
S. Commercial building, industrial building, multiple residences and similar buildings
• and installations, a certificate of Code Compliance from architect or engiocer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
1 8. For existing buildings (prioz to April 9, 1957) non-conforming uses, ar 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 Building - ;100.00
' 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00 ,
,S. Temporary Certificate of Occupancy - Residential $15.00. Commercial. ;15.00
October 27, 1995
Date
New Construction........... Old Or Pre-existing Building „ XX
Loc tion of Pro ert 460 Bay Avenue .East Marion,,,.,,,,,
P P Y
House No. .Street hamlet
' Joseph J. Dzenkowski
QRHer Or OWnera of Property
County Tax Map No 1000, Section „ 031 ,,,,Block... 08....... .Lot.. OA.$
Subdivision ....:...............................Filed Map............Lot.............:.......
Permit No....r......':y..Date OE Permit ................Applicant............................
lfealth Dept. Approval ..........................Underwriters Approval........................
Planning Hoard Approval
Request for: Temporary Certificate.:......... Final Certicace., xx~~ .
Fee 5ubmittedi j „ 100 00
Qi,~, 5035 William H. A$g4Jr. ,
~ ~y~) 1 attorney for owner
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CONSi;NT ;i 1497
'10
1NSPLCTiON
William H. Price, Jr., attorney for
Joseph J. Dzenkowski .the undersigned,
Owner(s) NAme(:i)
do(es) hereby state: ,
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at 460 Bay Avenue, East Marion, New York
which is shown and designated on the Suffolk
County tax map ns District lUUU, Section 031 131aek 08 Lot 008
Thai the undersigned (has) (have) filed, or caused to be filed, an applicn-
Lion in the Southold 7~own IIuilding Inspector's Office for the following:
private one family dwelling with attached porch and detached
shop building
That the undersigned do(es) hereby give consent to the building Inspectors
of the Town of Southold to enter upon the about described property, including
any and all buildings located lhercon, to conduct such inspections ns they may
deem necessary with respect to the aforesaid application, including inspections
to determine that said premises comply with nil of the laws, ordinances, rules
and regulations of thgTown ct 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-
lotions of the laws, ordinances, rules or regulations of the Town of Southold.
Dated: October 27, 1995
(signature)
William H. Price, Jr.
(print name)
. (sig~~ature) .
• (print name)