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Home My WebLink AboutZ-27792FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. OPDATED PRE EXISTING CERTIFICATE OF OCCUPANCY NO: Z- 27792 Date: 07/05/01 T~IS ~TIFIES that the building DWELLING & ACCESSORY Location of Property 15 FOURTH ST NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 0010 Lot 015 subdivision Filed Map No. __ Lot No. __ conforms st~bsta~tially to the Requirements for a built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NU~4BER Z- 27792 dated JULY 5, 2001 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 FAMILY DWELLING WITH COVERED FRONT AND REAR PORCHES AND CONCRETE PATIO AND AN ACCESSORY 1 1/2 CAR GARAGE WITH DECK.* The certificate is issued to RUTH C GOODALE of the aforesaid building. (OWNER) SUFFOLK COUNTYDEPARII~ENTOFHEAL'£aAPPR0~I~L ELE~-rKIC~J~ CERTIFICATE NO. PLUMBERS CERTIFICATION DA'£~3 *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A N/A Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT I~DCATION: 15 FOURTH ST NEW SUFFOLK SUBDIVIEION: ~ NO.: LOT NA~E OF O~FER (S): RUTH C GOODALE OCC~JPANCY: TWO FAMILY DWELLING RUTH C GOODALE · J~I'l'r~ BY: LISA JEROME ACCOMPANIED BY: ~Y A~I~BI*E: SUFF. CO. TAX ~ NO.: 117.-10-15 SOURCE OF P~EQUEST: ANDREA RIVE DATE: 07/05/01 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 2.5 # EXITS: 5 FOUNDATION: BRICK CELLAR: FULL ~ SPACE: TOTAL ROO~S: 1ST FISH.: 50 2ND FI&~.: 50 3P, D FI~{.: 0 Ba'r~l(OO~ (S): 3.0 TOILET ROO~ (S): 2.0 UTILI~"f ROOM (S): PORCH TYPE: COVERED FRONT & REAR DECK~"fPE: PATIO EP, EEZEWAY: FIP. EPLACH: TWO GAP, AGE: CEMENT ACCESSORY STRUCTURES: GA~Aa-GE, TYPE OF CONST.: 1 1/2 CAR WOOD FRAME STOP~%GE, TYPE CONST.: SWIPING POOL: GUEST, TYPE CONST.: ~r~K: DECK ATTACHED TO GARAGE VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION bESCRIPTION ART. SEC. DATE ON INSPECTION: 06/27/01 TIME ST~T: 10:10AM ~D: 10:50AM Form No. 6 ~'h 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 a~d 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 O~ 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 building~ and installations, a certificate of Code CQmp!ianae from architect or engineer· .responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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. Occqpancy 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 $25f00, Additions to accessory building $25.00. Businesses $50.00.. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.O0 3. Copy of Certificate of OccuPancy - i 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00,-Commercial $15.00 · ' . · ,s' _,-,,-,, ~--z.._. ~ ~ "~.-~ ' ,. ,ation of ,'roperty.. . :... ............... .,.,.,.,, ..... · ~ous~,~:' x-: ..... . ~ . Street County Tax Map No 1000, section. /~7.....cz. Bl'~ck../,~. .... '..~..Lot../~..: .......... Subdivision.. ..... ~ · ~ .......................... Filed Map ............ Lot ........ · ............. Permit No ................ Date Of Permit ........ ' ........ Applicant ....................... ~.'~ ~. ]{ealth Dept, Approval ........................ ...-Underwriters Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... 07/05/0~_.~.$:43 FA~_~,317270606 _~ID~LI~' NAT L ~002 State of New York ) County of Suffolk ) Affidavit of Two Family Use SS,' I, William Goodale, residing at #t5 Fourth 8treat, J4ew Suffolk, NY, being duly sworn do depose and say~ That the premises known ~B #15 Fourth Street h,:G been a two Family residence for my entire lifetime- first shared bah,teen my grandparents, Charles and Gertrude Hempel, ( w~ · acquired title In 1936) and my parents, Ruth and Andrew Goodale~ and later~ between my parents, Ruth and Andrew Goodale~ (who aoql,lired title from my grandfather in t 965} and my own family to the pr(~.sent day. The struGture as it pressnf, ly exists was Issued a two family G~of 0 #Z6046 in 1974 after an Inspection by ~:he town Ol~ Southold, end remains the same to this day. Tho purpose of this affidavit is to induc.~e the Tow ~ of 8outhold to amend the original pre existing C of O ~to Jnolude i'.ho pre-existing Garage, which appears on the t974 su[wsy submlttsd to tho Town of 8outhold to obtain said C of O, but wo]~ InadverteiTtly omitted from the original pre existing G of O. #Z6046. I make this statement knowing the Town of Sout',old will rely on the truth of same. / Sworn to~ ?/$t200~ ~'il ~ne R Qualified In Suffolk CONSENT TO INSPECTION Ortner (s) Name(s) ~ do(es) hereby state: That the undersigned (is) (are) the owner(s) of the premises in the Town · which is shown and designated on the Suffolk County tax map as District 1000, Section /(~ , Block /~ , Lot ~ That the undersigned (has) (have) filed, 'or caused to be filed, an applica- t~in the Southold Town Buildin~ Inspector's Office for the folloxving. at the underseas) hereby give consent to the Building Inspectors of the Town of Southoldto 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. (signature) (print name) (signature) ×0/~' GOODAL~ 83'48'00" 2-1/2 STORY FRAME HOUSE (~rHRE~RwN..KOUT ONC. BLK. BAS£~£NT) 85'51 '2,5" W GREAT ~/o/x LUCILLE COODMAN PF:CONIC BAY ~ 26.92': 12;