HomeMy WebLinkAboutZ-28110 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- 28110 Date: 12/11 O1
THIS CERTIFIES that the building DWELLING
Location of Property 4380 PARADISE POINT RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 081 Block 0003 Lot 006
Subdivision Piled Map No. Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NOMBER Z- 28110 dated DECEMBER 11, 2001
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
The certificate is issued to HENRY C ELFERS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTS EPORT.
_ /
Authorize Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATIOd: 4380 PARADISE POINT RD SOUTHOLD
SUBDIVISIOd: MAP dO.: LOT (S)
dAlDZ OF OMHB& (S): HENRY C ELFERS
OCCUPAdCY: SINGLE FAMILY HENRY C ELFERS
ADMITTHD HY: ACCOMPAMIHD HY:
RHY AVAILABLE: SUFP. CO. TAY MAP dO.: 81.-3-6
SOURCH OP RBQUEST: HELEN E. DIDRIKSEN, 11/28/01 DATE: 12 11 O1
DWELLING:
TYPH OP COdSTEUCTIOd: CONCRETE BLOCK # STORMS: 1.0 # BRITS: 3
POUBDATIOd: CEMENT BLOCK CBT.LAR: FULL CRAdL SPACE:
TOTAL ROOMS: 1ST PLR.: 4 2dD PLR.: 0 3RD PLR.: 0
BATHROOM(S): 3.0 TOILET' ROOM(S): 0.0 OTILITY ROOM(S):
PORCH TYPE: REAR SCREENED DHCR TYPE: PATIO TYPB: WOOD
BRSEZHfAY• FIREPLACE: 2 GARAGE:
DOl~STIC HOTMATSR: XX TYPH ~ATBR: ELECTRIC AIRCOdDITIOdMG: CENTRAL
TYPH HHAT: OIL iO1RM AIR: dOTWATBR: XX
OTHHR: BASEMENT EXIT
ACCESSORY STRUCTURES:
GARAGH, TYPH OF COdST.: 2-1/2 WOOD FRAME STORAGB, TYPH COdST.: SMALL METAL SHED
SdIMMMG POOL: GOEST, TYPE COdST.:
OTHHR:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. ~ SEC.
RIDIARHS: BP #3272 O Z-2651 - (ACCESSORY GARAGE)
IRSPECTED BY: DATE Od IdSPHCTIOd: 12 07/01
J M. HOUFIS TIMH START: 9:40 AM BdO: 10:15 AM
Form No. 6 D
TOWN OF SOUTHOLD D
BUILDING DEPARTMENT !',~~'r 2 8
TOWN HALL
765-1802
' .SLOG. DEPT
APPLICATION FOR CERTIFICATE OF OCCUPANCY F S p
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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 Boazd of Fire Underwriters.
4. Swom 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 similaz 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. For existing buildings (prior to Apri19, 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. Photocopy of Certificate of Occupancy - $ 0.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ~n~ ~ ~
Date. ,l~Z'~ ~ z. 2 po
New Constmction: 17 p Old ornPre-existing Building: ~ (check one) ~
Location of Property: 7 p ~ U(~-~.EdGL~•~ ~ u'`~ Ire l~~-f
House No. Street ~ ~ Hamlet
Owner or Owners of Property: ~,~Fit~. (~1L'C-1R-J~fi` /
Suffolk County Tax Map No 1000, Section p { Block ~j Lot
Subdivision Filed Map. ~ Lot:
Pernut No. Date of Permit. ~ Applicant
Health Dept. Approval: Underwriters Approve
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
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Fee Submitted: $ ~ ~ ~ ~ , / ~c,.{~
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Applicant Signature L,
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