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- FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-19079 Date MAY 25, 1990
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 30145 COUNTY ROAD #4B PECONIC, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 74 Block 1 Lot 37.2
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-19079 dated MAY 25, 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 DWELLING WITH ATTACHED 2 CAR GARAGE *
The certificate is issued to JOHN P. 6 BARBARA C. EBELING
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NO RECORD PRE EXISTING
UNDERWRITERS CERTIFICATE N0. NO RECORD PRE EXISTING
PLUMBERS CERTIFICATION DATED NO RECORD PRE EXISTING
*PLEASE SEE ATTACHED INSPECTION REPORT.
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Building I Spector
Rev. 1/B1
•
" • BUILDIe:G DEPART:IEiT
T0,•Ji`T OF SOUTHOLD, N. Y.
HOUSI;IG CODE IiISPECTION REPORT
Location 30145 COUNTY ROAD #48 PECONIC, N.Y.
~ni:moer do street) f~iunicipality)
Subdivision P•tap No. Lot(s)
Na,-ne of O~~~ner(s) JOHN P. 6 BARBARA C. EBELING
OCCUpariC`f SINGLE FAMILY DWELLING
(type oomer-tenant )
Admitted by: SPARKY COYLE Accompanied by• SAME
Key available Suffolk Co. Ta:t No. 1000-74-1-37.2
Source of request Date
D'~IELLI`1G
Type of construction WOOD FRAME ~rstories ~
Foundation coxcxETE BLOCK Cellar x Crawl space partial
Total rooms, 1st. F1 ~ 2nd. F1 3rd. F1
Bathroom(s) ~ Toilet room(s) ~-~/Z
Porch, t• e - - Deck type - Patio typE. s ate front
,~'p , , i concrete-rear
Breeze:•~ay - - Garage 2 car Utility room - -
Type Heat OIL aOTWATER +Varm Air Hotwater 'a
Fireplace(s) ~ No. E;tits 3 Airconditioning
Domestic hotwater ~ Type heater FDRNACE
Other DETECTOR BY BEDROOM
ACCESSORY STP.UCTURES: NONE '
Garage, type const. Storage, type const.
Swi.~uning pool Guest, type const.
Other
VIOLATIODIS: .CHAPTER 45-N.Y. STATE UNIFORM FIRE PREVENTION S BIIILDING CODE
Ln_cation Description IArt.I Sec.
I
xoxE
I
I
Remarts
Inspected by: Date of Insp.'" 5/24/90
Vincent R. Wieczorek ~ Tlme Start 3° tD fiend 3:30 pm
Form No. 6 ~ L1 V L5 ss
D i,
TOWN OF SOUTHOLD II_S
BUILDING DEPARTMENT MAY 2 (1990 ' ,
TOWN HALL I ! ~f
765-1802 ~
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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 17 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.
/ B. J 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $1/5.00, Commercial $15.00
Date ..,J. ~1.~~
New Construction........... Old Or Pre-existing Building
Location of Property... `3O/~jS....~OL~TE..~$~........~COA/lG../VY
House No. Street Hamlet
Onwer or Owners of Property..7I~N11/ P AAfO Bi4rC'1:~4iP4 e. EBEUAIG
County Tax Map No 1000, Section....~.......B1ock....~...........Lot..37'2' .
Subdivision ....................................Filed Map............Lot..............._......
Permit No ................Date Of Permit................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate
Fee Submitted: $
f~~-c, 3953
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