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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-20623 Date APRIL 1, 1992
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 705 FIRST ST.&17245 NEW SUFFOLK AVE. NEW SUFFOLK
House No. Street Hamlet
County Tax Map No. 1000 Section 117 Block 8 Lot 14.2
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-20623 dated APRIL 1, 1992
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 WILLIAM C. FISHER
(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.
L ~C./
Building Inspector
Rev. 1/81
_ ,
BUi:.Dl:: Ds.L:u?1:,._.ilT
TO'rRd Or SOUT:iOLD, i\I. Y.
F.'OUCIi:G CODE IiiS?ECTIOiI REPORT
Location 705 FIRST ST. 6 17245 NEW SIIFFOLR AVE., NEW SIIFFOLR, N.Y.
~r,anocr ~x srsee~) li•iun~cipality)
Subdivision Dian No. Lot(c)
Na.;le of Otimer(s) WILLIAM FISHER
Occupancy A-I OWNER
(type) o:m er-tenanti)
Admitted by: WILLIAM FISHER Accompanied by: SAME
Key available Suffolk Co. Ta:c No. 117-B-14.2
Source of request WILLIAM FISHER Date MARCH 26, 1492
D`..
~LLI PTG
Type of construction WooD FRAME stories 0x6
Foundation CEMENT BLOCK Cellar F~L Crawl space
4'otal rooms, 1st. F1 4 2nd. Fl - - 3rd. F1 - -
Bat,broom(s) 1 FDLL BATH Toilet room(s)
Porch, type sCREEB Deck, type Patio, type_
Breeze~:ray Garage Utility room
Type Heat OIL +larm Air ~ Ho twater
Fireplace(s) No. E:cits A.irconditioning
Domestic hotwater n'S T•~-oe heater ELBCTRIC HOT WATER HEATER
Other
ACCESSORY ST??UCTURES: NONE
Garage, type const. Storage, type const.
Swi~.~ming pool Guest, type const.
Other
VIOLATIONS: .CHAPTER 45--N.Y. STATE UNIFORM FIIUi PREVENTION S BUILDING CODE
Location DPscrintion IArt.I Sec.
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Remar'ts: BP #20506-Z CO Z-20621 ISSUBD FOR ADD 6 ALT. BP #10395-Z CO 2-20622 ISSUED
FOR ADD ON
Inspected by: -~!/C Date of Insp. MARCH 26, 1992
J. FISB • Time start 9:40 end 10:00
r^' "`~0 Form No. 6
TO[JN OF SOUTIIOLD
~t~ BUILDING DEPARTMENT
~ M~ ~ ~ ~ TOWN HALL
_ 765-1802
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' F a
TO5^~
APPLICATION FOR CERTIFICATE OP 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.
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B. 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 an 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 $15.00, Commercial $15.00
~j~4/~
Date
New Construction........... Old Or Pre-existing Building..LC 1...........
Location of Property ..........................~.'eJ .'T .~~/44~%....... ~c=za) w~,Foc./~
House No.' Street Hamlet
Onwer or Owners of Property...~';U C (J~1 . C... >~I S~i~~ . .
County Tax Map No 1000, Section.,..l~ 7:.....B1ock.....~..........Lot... l
Subdivision ....................................Filed M:tp............Lot.....................
Permit No ................Date OC Permit................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate.~R ~
i'ee Submitted: ~L°.G':.~, ~
APPLICAiQT
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IN`~C'GC'CION
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U1~tLC/~1 ISI-~~ the undcrsi,~ncd,
Oumcr(5) Namcl:;)
do(es) hereby state:
That the undersigned (is) (arc) the owncris) of the prcmisca in the Tocm
of Southold located at ~ C'c~+.fi_~' O~ ~~f7°v ~7~`~"z~J
~:~hich is :shown and designated on the Saffolk
County tax map as District 1000, Section ~ ~ L'lock ~ Lot ~4~,z ,
That the undersigned (has) (have) filed, or caused to he filed, an applica-
lion is the Southcld Ton~n L'uilding Insnector's Office for the follo;ving:
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 lases, ordinances, rules
and regulations of the Town cf Southold.
The undersigned, in consenting to such inspections, do(es) so n'ith the
l:nov:ledge 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 To:vn o/f Soufhold.
Dated: 3~~' Id~~/ _ /l~~cY~lxf ~r~T.""~
(signature)
(print name)
(print Hamel