HomeMy WebLinkAboutZ-24024 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRS E%ISTING
CERTIFICATE OF OCCUPANCY
No 8-24024 Date NOVEMBER 9, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 6555 NSW SUFFOLK RD. COTCHOGIIS, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 5 Lot 26
Subdivision Filed 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 NUMBER Z-24024 dated NOVElIDER 9, 1995
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate ie
issued ie ONE FAMILY DWELLING WITH ACCESSORY GARAGE
The certificate ie issued to MARY FERGUSON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLSASE SEE ATTACHED INSPECTION REPORT.
B ilding Inspector
Rev. 1/81
- (3111 LD 1 Nli Ill•:I'Alll'MI:N'I'
TOIJN ON SOU'CIIOLD
IIOlIS1NG CODIi INSf'ECI'lON ItEI'DIYf
IOCA'1'IONO 6555 NEW SUFFOLK ROAD CUTCAOGUE, N.Y.
----~numher 6 s[roc[:)-__ ---~___rinunicipal ily}
5111)llIVISION _ NAl' NO, LO'I'(s)
NANa: ov ouNl(R (ti) MARY FERGIISON ~ _
000III'ANCy A 1 RES. f '------OLiNER
lypc~--- --Zouner-Lenant~
ADNI"l"Pull IIY: JAMES DODBLEDAY Af.CONI'ANI(iU ISY: SAMB
KI•:Y AVAI LAISLI'. _-_-__~`_~-----i_-`i Ul'I~.CO. 'l`AX r(AL' Nll. 100U=T1~~Z6~- _
SOl1NL'li OF REQIII;S•r: WILLIAM JARLEVIC DATE: OCT. 27, 1995
-
UWELLING:
'I'YI'E OIL CONS'1'RI1C'1'ION HOOD FRAME 1 S'rOfti L'S 2 / EXlI'S 2
I'OIINIIA'I'lON _ _C_~NT _ CGLLAR_~'I' CKAHL SPACN. ~
'1'O'l'AI. I200MS: IS'C FLR. 3 2NU P1.R. 3 3RD Pl.lt _ -
1SA'1'111tO0M (s) _ ON6 ~~~-~l'O f LET I200M (s) ONS U't'I LI'L'Y It00M
POItCII 'I'YPIi COVERED DECK, 'T'YPE ~ ~ PATIO
IS ItEI?'LEWAY FLRIiYI.ACE _ GARAGE
U(IMI: S'1'[G IIO'I'NA'1'li It YES TYl'li IIGA'1'I~It OFF BOILER _ AI K(:ONDI'CLONINC.
'1'Y I'E IIIi A'1' OIL NAlirl Allt 110'1'NA'I'Elt ~
O'CIIEIt:
ACI:ESSO_RY 5'1'Rll(:'1'URES:
GARAGE , '1'YPI', OF CONS'I•. 1 CAR WOOD FBAME STORAGE, 'T'YPE CONS'r.
SNINMING POOL_ 6111:5'1', 'fYPL•' CONSI'.
O'1'llEli:
VIOLA'I'I(1NS: GIIAI''fG(t 4S N.Y. S'('ATE IINIi'OItM FIRE PItEVEN'rION b lIl1ILUING COUE
LOCATION DESCRII''170N Alt"r. SEG.
RlsNnurs:
1 Nf: Pk: CI'I{D 1SY ' DA'1'h: Of 7NSPEC"PION OCT. 13, 1995
- N
rlm: s'rnR'r 10:02 END 10:30
Form No. G
iC
'I'UWN OP SOU'I'IIOLU
BU1.LUING OFPA42'fffliN'1'
..I 27 ~ '1'oWN 1{ALI.
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E f r.
rn ,_~y~_~..._V si?l.f)~ API'L[CA'I'JON TOIL CIiR'1'll"LCA'1'li OF OCCUPANCY
A. This appli^ation musC be filled in by typewriter OR i.nk and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate l.ocaCi.on o[ all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from IIea1Ch Uept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installaCion 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. SubmiC Planning Board Approval of completed site plan requirements.
B.• For existing buildings (prior to April 4, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual naCUral or topogcapl~ic features.
2. A properly completed applicaelun and a consent to inspect signed by the applicant.
If a Certificate of Occupancy 1s deni.ed, the Butlding inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dweLli.ng $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions tp 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 ....4eto~4~'.2.7.R.]-99.x
New Construction........... Old Or Pre-existing Building.....K...........
Location of Property,,,6555. .New Suffolk Road Cutchogue.
House No. SCreet .Hamlet
Onwer or Owners of Property..,,Mary Ferguson
County Tax Map No 1000, SecCion.,,117: 0~,,,,B1ock....Q`~: QQ......Lot.....Q2~;.QQO.........
Subdivision ....................................Filed Mal,............Lot......................
Permit No ................DaCe Of Permit................Applicant.............................
Health DepC. Approval. .........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Cerl'iEicaCe........... Final CertlcaCe...~.......
Fee Submitted: $„100.00.. {
....~'~,Nl. ~t,r
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CONSENT
TO
INSPECTION
WILLIAM JAKLEVIC the undersigned,
Owner() Name66)
do(es) hereby state:
the Executor of the fate of Mary Ferguson
That the undersigned (is)/(tee) the owner~Ia~ of the premises in the Town
of Southold located at. 6555 New Suffolk Road, Cutchogue, New York
which is shown and designated on the Suffolk
County tax map as District 1000, Section 117 Block 5 Lot 26
That the undersigned (has) bi~caeak filed, or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
Certificate of Occupancy on Pre-existing Building
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 subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations of the Town of Southold.
Dated: October 27, 1995_ n.~Lc
(signat e
William Jaklevic
(print name)
(signature)
(print name)
~3y- ,~90~