HomeMy WebLinkAboutZ-26011FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 26011
Date: 10/06/98
THIS CERTIFIES that the building DWELLING
Location of Property 4950 NORTH BAYVIEW RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 079 Block 0002 Lot 005
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- 26011 dated OCTOBER 6, 1998
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 ACCESSORY GARAGE *
The certificate is issued to J.F. & ALICE GAGEN
(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 INSPECTION REPORT.
=2:L
B X�ein Inspe for
Rev. 1/81
SUBDIVISION:
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
MAP NO.: LOT (S)
NAME OF OWNER (S): J F & ALICE GAGEN
OCCUPANCY: A-1 RESIDENTIAL J.F. & ALICE GAGEN
ADMITTED BY: JOAN SLEDJESKI ACCOMPANIED BY: SAME
KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 79--2-5
SOURCE OF REQUEST: JOAN ST.F.DJESKT - 9/16/98 DATE: 10/06/98
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 # EXITS: _3
FOUNDATION: CEMENT BLOCK CELLAR: FULL CRAWL SPACE:
TOTAL ROOMS: 1ST FLR.: .-k
BATHROOM(S): 1.0
2ND FLR.: 0
TOILET ROOM(S): 0.0
PORCH TYPE: SCREENED IN DECK TYPE:
BREEZEWAY:
FIREPLACE:
3RD FLR.: -Q-
UTILITY ROOM(S):
GARAGE:
PATIO TYPE: CONCRETE
DOMESTIC HOTWATER: YES TYPE HEATER: OFF BOILER AIRCONDITIONING:
TYPE HEAT: OIL WARM AIR: HOTWATER: XX
OTHER:
GARAGE, TYPE OF CONST.: WOOD FRAME STORAGE, TYPE CONST.:
SWIMMING POOL:
OTHER:
GUEST, TYPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY:
GARY .Y. F
DATE ON INSPECTION: 09/23/98
TIME START: 10:15 AM END: 10:35
r
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OF, 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 1% 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. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and
t1pre-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.
i
C. Fees
r 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 $15.00, Commercial $15.00
Date............ 1,�..........................
New Construction........... Old Or Pre-exist'ng Building.........
Location of Property........ q�0...lel :.�l] .�i.W ..Ak.......... Cl.`k..........:
House No. Street Hamlet
Onwer or Owners of Property........ «.�s..�L:Y....... ..............................
County Tax Map No 1000, Section..... 77 .....Block... .........Lot.. .................
Subdivision...... ................... .... Filed Map..... .....Lot......................
Permit No ..... V/14Date Of ermit.... /f..............
.Applicant ..................
Health Dept. Approval.........!..!:........ ..Underwriters Approval. 6 ...................
Planning Board Approval......L" ./.�..............
Request for: Temporary Certificate........... Final Certicate. .....
Fee Submitted: $...1W ................ ...
...:..........................
5% r ,,, �r �) I A LICANT
o IANC
s
. C;6,
X3690 ;
oFNEW
's Z/o 2 Z' 3a''rc/
Z�y,G//. 'w
3ueyEYf'o.�TiS'i
Loc,97-10 �ouryotp ✓�`uF.Cvc. L'c�w N• y��r,�o,N• s�ii9�i
0 wncr(s) N
c(:;)
C:0NSr•_;,T
TO
IN.11 PCCT10N
the undersigned,
do(es) hereby state:
That the undersigned (is) (,Ire) the owner() of the premise:; in the Tovm
of Southold located at
I el
�t•hicli is :;hovm and dcsirnated on the Suf;o1::
County tat map as District 1000
Section Block, Lot
That the undersigned (has) (Gave) filed, or caused to be filed, an applica-
tion in the Southcld To%cm Building Inspector's Office for the follo%vine:
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 inspec:iors
to determine that said premises comply with all of the la%c•s; ordinances, rules
and regulations of the Town cf Southold.
The undersigned, in consenting to such inspections, do(es) so %vith the
knov.,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 Town of Southold.
Dated:_
(sign ure)
( print nail )
(signaturC)
(print name)
LOCATION:
SUBDIVISION
NAME OF OW
OCCUPANCY
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
y m /�- `
,2 '-/ - ",z�
number & street municipality
EMAP NO.LOT (s)
ADMITTED BY: N/,/ CC44,flr llt;�- ACCOMPANIED ^BY:
KEY AVAILABLE// '� SUFF. CO. TAX MAP NO.�1 �.
SOURCE OF REQUEST: �O,A� �(.�/S,1 �S/�DATE:
DWELLING:
TYPE OF CONSTRUCTION W /�n.��, # STORIES
/- # EXITS
FOUNDATION S-�fw� CELLAR ?Arz CRAWL SPACE
TOTAL ROOMS: IST FLR.(o 2ND FLR. 3RD FLR.
13
BATHROOM (s) (/1�.�_ _ TOILET ROOM (s) UTILITY ROOM
PORCH TYPE DECK, TYPE PATIO, TYPE --'
BREEZEWAY FIREPLACE GARAGE
DOMESTIC HOTWATER TYPE HEATER cJ/-qL6t_ AIRCONDITIONING
TYPE HEAT WARM AIR HOTWATER
OTHER: .
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. %�Q STORAGE, TYPE CONST.
SWIMMING POOL GUEST, TYPE CONST.
OTHER:
-----------------------------------------------------------------------------------------
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
REMARKS:
INSPECTED BY: DATE ON INSPECTION IIJ3 Z 7 6
TIME START- 1®% 1r, END _ le ; S