HomeMy WebLinkAboutZ-16513 FORM N0.4
TOWN OFSOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
PRE C.O.
No. 216513 December 17, 1987
Date
THIS CERTIFIES that the building G a r a g e
Location of Property .,3645 Cty. 1148 & ]25 Lipco Road Mattituck
NouseNo ........................Street.......................Ham/et
County Tax Map No. 1000 Section ? 4 1......Block ....3 ..........Lot I. ~ .
Subdivision ...............................Filed Map No. ........Lot No. .
REQUIREMENTS FOR A GARAGE BUILT PRIOR TO
conforms substantially to the AL~i~:31tYo`ill'O`E~iiLf~t~XP~di~F~'tY~lXi$i~f~i~~~~
April 23, 1957 CERTIFICATE OF OCCUPANCY
• pursuant to which1i6i3~~'i6~iK No. Z 16 5 1 3
dated Dec: 17 , 19 8 7 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 .
TWO. c.di. 8ara8!?. .Cacce,s,sorY..~
The certificate is issued to ....ANDREW C . FOHRKOLB
owner. %xx .
of the aforesaid building.
Suffolk County Department of Health Approval N / A
UNDERWRITERS CERTIFICATE NO . N /A
PLUMBERS CERTIFICATION DATED:
Also Pre C.O. liZ16267 10/8/87
Building Inspector
Rw. 1/81
BUILDI•iG DEPT-RT:•LiT
TO';~~T OF SOUTHOLD, N. Y.
HOUSIiTG CODE INSPECTION REPORT
Location 3645 Cty. X148 & 125 Lipco Road Mattituck
~rumoer do street i%Iun~cipality)
Subdivision riap No, Lot(s)
Name o2' 0~•rner(s) ANDREW C. Fohrkolb
Occupancy unoccupied
~ typ e o~•mer-tenant
Admitted by: self Accompanied by:
Key available Suffolk Co. Tax No. 141-3-17
Source Of request Helen J. Rosenblum Date Nov. 2D, 19.87
DTr1ELLI~TG
Type of construction #stories
Foundation Cellar Crawl space
Total rooms, 1st. F1 2nd. F1 3rd. Fl
Bathroom(s) Toilet room(s)
Porch, type Deck, type Patio, type_
Breeze;•~ay Garage Utility room
Type Heat 'alarm Air Hotwater
Fireplace(s) No. E:cits Airconditioning
Domestic hotwater Type heater gas heater
Other
ACCESSORY STRUCTURES:
Garage, type const. 2 car wood Storage, type const.
S~•~imming pool Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 4.5 N.Y. State Uniform Fire Prevention
& Building Code
Location Description Art.{ Sec.
NO VIOLATIONS
This two car ara a is •
property with a 2 family dwellin¢ and
an they utilit buil 'n 1
1
Remarks•
Inspected by: Date of Insp. 12/7/s7
CURTIS W. Horton Time startlo:00 end 10;15
ppn~
\s1~
2 ~ ~ COA'SENT
TO
INSPECTION
i~J p(~~ a ~ ~~~L~ ,the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (are) th/e~vo~w~ner(s) of ther~p~re,,m~is~es in the Town
of Southold located at ~ Z Ltuz-V 1 ~ ~i~ll G(.7~L~~~
which is ~s/hown and designated on thel Suffolk
County tax map as District 1000, Section ~ Block 3 Lot _I
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in the Soupthold Town Building Inspector's Office for the following:
1Q ~ I~~C'i -
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 ail 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: ~'~~~-1r ~ LoT ~ W4~~i~ ~-I-DW~.~L
(signature)
(print name)
(signature)
(print name)
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ to the Building Inspec-
torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Additions $25.00
1. Certificate Of Occupancy New Dwelling. $25.00, Accessory 10.00 Business $50.00
2. Certificate ofaccupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4. Vacant Land C.O. $ 20.00
S.Updated C.O. $ 50.00 Date
New Construction,,,,,,OldorPre-existing Building ..XX....... Vacant Land
Location of Property 3645 Cty /148 & ]25 Lipco Rd. Mattituck
House No. Street Hamlet
Owner or Owners of Property ANDREW C . FOHRKOLB
County Tax Map No. 1000 Section ~ 4 Block ..3............ Lot .....1.~ .
Subdivision .................................Filed Map No. ..........Lot No. .
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval ........................Labor Dept. Approval .
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ .
Construction on above described building and~e(r~mi~t
mneets all applicable codes~ar0n~d~.regulations.
Rev. 1010-78 l ~ ly'q.r, UUU