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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
Z-24940 Date MARCH 19, 1997
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1395 OLD SHIPYARD LANE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section
Subdivision
64 Block 5 Lot 27
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-24940 dated MARCH 19, 1997
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 VIRGINIA GOHIER
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Bui ring Inap for
Rev. 1/81
BUILDING DEPARTMENT
TOWN of SOUTHOLD
DOUSING CODE INSPECTION REPORT
LOCATION: 1395 OLD SHIPYARD LANE SOUTHOLD, N.Y
number h street municipality
SUBDIVISION MAP NO. LOT(s)
NAME OF OWNER (s) VIRGINIA GOHIER
OCCUPANCY SINGLE FAMILY
type owner -tenant
ADMITTED BY: PAUL BAKER ACCOMPANIED BY: SAME
KEY AVAILABLE SUFF.CO. TAX MAP NO. 1000-64-5-27
SOURCE OF REQUEST: PAUL A. CAMINITI, ATTY DATE: MARCH 5, 1997
DWELLING:
TYPE OF CONSTRUCTION
FOUNDATION BLOCK
TOTAL ROOMS: IST FLR
BATHROOM (s) 1
PORCH TYPE
BREEZEWAY FIREPLACE
DOMESTIC HOTWATER LILCO GAS TYPE. HEATER
TYPE HEAT LILCO GAS WARM AIR
WOOD FRAME
CELLAR PARTIAL
2ND FLR. 2 3RD FLR.
TOILET ROOM (s)
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.
SWIMMING POOL
OTHER:
DECK, TYPE
LILCO GAS
1 STORIES 1-1 2 i ERITS_2
CRAWL SPACE PARTIAL
UTILITY ROOM yEg
WOOD PATIO
GARAGE
AIRCONDITIONING
HOTWATER Yx
STORAGE, TYPE CONST.
GUEST, TYPE. CONST.
SHED
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION 1: BUILDING CODE
REMARKS: BP 1)23985-Z-COZ-24938 (deck) CO Z-24939 (Accv Shed)
INSPECTED BY / i Z'e4K'�/ DATE OF INSPECTION MARCH 7,1997 -REINSPECTED 3/13/9
Michael Verity TIME START 10:30 END 11:00
S
79'44.4Q,. NNE FDCE
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Apr -;j R?VE 1 .76'
41
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Mrs Slow
NFRAME SHO ri
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.4w.
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an
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FRAME5S-851
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�41
SURVEY OF.
LOT 113
SUBDIVISION MAP OF
FOUNDERS ESTATES
FILE No. 834 , FILED MAY 10, 1927
SITUATED AT
SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-64-05-27
SCALE 1"=20'
To O
FEBRUARY 20, 1997
o CERTMED Tp
PECONIC ABSTRACT, Inc.
FLATBLIS7H FEDERAL SAVINGS AND LOAN ASSOCIATION -
wk;2: PALILW. BAKER
d C) as LINDA S. BAKER
V,
O -
o0 A
his AREA = t1,572.69 sq. ft.
0.266 cc.
0
IW NEW YaW SUlt
or mm sum�;�'
TME LAND SNAWWS #ago SpNmL,war4-1
ca"Ime",
cumqlaulams
ONLY le 7m, pulaw tta�qMAW
meumpl
pmp%mm� , aw
7= ON~. saw"Glimm MEW
LDOW AM
'ANM,
admwjm* umm munw.
TO Tw. orl
xnm
TK E'XMTEI= 'OF MOM OF -i
or Ramm IF_-."
SNOWWAK PW QUARA10IM—
M.L.
%A
J0
AN
Land
ftypr,
MIM (916)7272090
`Z
zz
S
79'44.4Q,. NNE FDCE
zor
% FbiCe Fe'a, Foict
Apr -;j R?VE 1 .76'
41
Cft
Mrs Slow
NFRAME SHO ri
Z61T >13
cau*
FMW SqD
FftN& SHM
.4w.
114
N?wr ftftmv SOW
N79-44'4t)ar
waid.
La 14 Cft
ev
an
zor
FRAME5S-851
t/
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�41
SURVEY OF.
LOT 113
SUBDIVISION MAP OF
FOUNDERS ESTATES
FILE No. 834 , FILED MAY 10, 1927
SITUATED AT
SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-64-05-27
SCALE 1"=20'
To O
FEBRUARY 20, 1997
o CERTMED Tp
PECONIC ABSTRACT, Inc.
FLATBLIS7H FEDERAL SAVINGS AND LOAN ASSOCIATION -
wk;2: PALILW. BAKER
d C) as LINDA S. BAKER
V,
O -
o0 A
his AREA = t1,572.69 sq. ft.
0.266 cc.
0
IW NEW YaW SUlt
or mm sum�;�'
TME LAND SNAWWS #ago SpNmL,war4-1
ca"Ime",
cumqlaulams
ONLY le 7m, pulaw tta�qMAW
meumpl
pmp%mm� , aw
7= ON~. saw"Glimm MEW
LDOW AM
'ANM,
admwjm* umm munw.
TO Tw. orl
xnm
TK E'XMTEI= 'OF MOM OF -i
or Ramm IF_-."
SNOWWAK PW QUARA10IM—
M.L.
%A
J0
AN
Land
ftypr,
MIM (916)7272090
OFR= WCA7M AT
aft.lawn sq,.*
Aquabopm, N&N York 11931
I AftWivvAm
OW'
Nor r4*4;901
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 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 1% lead.
5. Commercial building, industrial building, multiple residences and similar bull.dings
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,
"pre-existing" land uses: 1957) non -conforming uses, or buildings and
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
I. 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 - .251c
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential
%x$15.00, Commercial $15.00
Date .....r! Ct4 5 ! q q7
New Construction........... Old Or Pre-existing Building...✓
Location of Property....... �3�� 6.(.0`J/�rh•�O�.ep C
House No. Street
Hamlet
Onwer or Owners of Property...........
County Tax Map No 1000 Section. /O .�
Block ....
... .........Lot. ..�. 7 ...............
Sul)division....................................Filed Map ............ Lot ......................
Permit No................Date Of Permit ................ Applicant .............................
Health Dept. Approval..........................Underwriters Approval.........................
Planning Board Approval ........................
Request for: Temporary Certificate........... Final Certic
Fee Submitted: $... (0- .. ..................
6,,c.52L�9
761 ���'
/ak.�ADMITTED BY: ACCOMPANIED BY:
KEY AVAILABLE SUFF . C6. TAX MAP NO . /000- �/ - S — 2'7
SOURCE OF REQUEST: �u,... DATE: 3 S 7
DWELLING:
TYPE OF CONSTRUCT ON # STORIES � - # EXITS Z
FOUNDATION CELLAR yj.64440' _ CRAWL SPACE
TOTAL ROOMS: IST FLR. 2ND FLR. Z 3RD FLR.
BATHROOM (s) TOILET ROOM (s) UTILITY ROOM
PORCH TYPE DECK, TYPE ctmo og PATIO
BREEZEWAY_ _ FIREPLACE GARAGE
DOMESTICHOTWA��R '� TYPE HEATER AIRCONDITIONING
TYPE HEAT a�"y"+� —�— WARM AIR HOTWATER—
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. STORAGE,
SWIMMING POOL GUEST, TYPE CONST.
OTHER:
TYPE CONST. -.1
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION
REPORT
LOCATION:
�-►•
/ �`�
/�
v� A�
number
& street
municipality
SUBDIVISION
F MAP NO.
LOT(s)
NAME OF OWNER
( s )
G�+
OCCUPANCY
ro„
owner -tenant
/ak.�ADMITTED BY: ACCOMPANIED BY:
KEY AVAILABLE SUFF . C6. TAX MAP NO . /000- �/ - S — 2'7
SOURCE OF REQUEST: �u,... DATE: 3 S 7
DWELLING:
TYPE OF CONSTRUCT ON # STORIES � - # EXITS Z
FOUNDATION CELLAR yj.64440' _ CRAWL SPACE
TOTAL ROOMS: IST FLR. 2ND FLR. Z 3RD FLR.
BATHROOM (s) TOILET ROOM (s) UTILITY ROOM
PORCH TYPE DECK, TYPE ctmo og PATIO
BREEZEWAY_ _ FIREPLACE GARAGE
DOMESTICHOTWA��R '� TYPE HEATER AIRCONDITIONING
TYPE HEAT a�"y"+� —�— WARM AIR HOTWATER—
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. STORAGE,
SWIMMING POOL GUEST, TYPE CONST.
OTHER:
TYPE CONST. -.1
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY
C ONS IiNAT
TO
INSI'I C:'l't0N
uf N l A0911 'p" the undersigned,
Owners) 1` all-te(s)
c.lo(cs) hereby state:
That the iinclersif;ried (is) Gore) tho owner(s) of the, premises in th(,: 'Town
of S;milhold located it
)V - whir:h is shown and desigmAted on the tiuffollc
(.hilly tax map ns I)istrict 1000, Section r0 Block ol: 2 /
That the rindersigilecl (has) (have) filed, or caused to be filed, an applica
tioii in the Sou old 't'owri 13uildilig Inspeclor's Office for the followi.nq:
pEC,K AND ---------
vied
t
P 62-42Z- Ad lo
S I"oeA �' f3v� � vi,Ug
Tient (he. rrndc:r•sif;ned clo(c:s) herehy giv" cor►sont to (hes Hilildinl hispeclor•t:
of Ilrc 'Town of Southold to cider upon (he ahovc described properly, hiclildinf;
ally mid all'hulldings located thereon, to conduct such irispec(tolls as Choy Inay
doe eju necessary with respect to the aforesaid application, including inspeel ions
to dutc!rmine that said premises comply with all of (lie laws, ordinances, rules
aucl r•r:i;ulations of the 'Town c;f- Southold.
The undersigned, in consenting; to such i.nspuctions, do(es) so with thE:
lcrrowlcdge au;d miderstanding that any inforniatiori olrlaii►ed hl the conduct of
such inspcctlons may he used as evidence in subsequent pr•o,ytcutious for• vio-
lal.ion-; of the laws, ordinances, rules or regirlalloris cofAfe Town SS,ulhow.
L A.1
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