HomeMy WebLinkAboutZ-24300FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
~ERTIFI~AT~ OF OC~umANCY
No Z-24300
Date APRIL 23, 1996
THIS CERTIFIES that the building
Location of Property 1725
House No.
County Tax Map No. 1000 Section 106
Subdivision
ONE FAMILY DW~Z.ING
MATTITUCK~ N.Y.
Street Hamlet
Block 7
Filed Map No.
Lot 9
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~24300 dated APRIL 23, 1996
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 DW~.TNG *
The certificate is issued to MARTIN L. GRIFFIN
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*P?.~%SE SEE ATTAu~U INSPECTION REPORT.
Rev. 1/81
./A
N/A
IHI 1 !.1)1 tiff I)Ir.I, AII'IHIr. HT
TI)~ll OF SOUTIll)I.D
IIOll~ IIlG CI)I)F. Itl.qPI[CTIOH RF.I'ORT
MATTITUCK, N.Y.
HAP HO. I.OT(~)
A-I RES.
lqARTIN L. GRIFFIN
O~/NER
ACCOHFAHIEI) BY'. S~
· ~tIFf~.(:t). 'FAX HAl' ~(). 1000-106-7-9
S()lllH~.lg ()IT IlE()lll~.fi'l': MARTIN L. GRIFFIN
l)^TF.: [larch 27s 1996
I)I./IH,L 1 IlO:
'I'YFE OF CONSTItUCTION
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OTIIER: WOOD STONE
WOOD FRAME
C~NT BLOCK CEI,I.AI1, PARTIAL
IST F'I.R. .~ 2ill) Fl,lt. 3ltl) FIAt.
ONE FULL BATH 'ro I I.ET ItOOtl ( n ) ONE
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OFF BOILER
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CII^!41, SI'ACE
IJTli. ITY ROOtl WASHER DRYER
NEAR PATIO
GAIIAGE
A ! IIC()HI) IT ! OH I
IIl)'rldATEl~ XX
ACCESSORY ,qTRUC'FUI(ES: NONE
(:AIIAGE, T¥I'Ir. OF CON,q'F.
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ItEHAItF.,q: BP #7626Z-COZ-6362 (ADD), BP {{17724-Z-CO Z-17635 (DECK)
I H!;I'ECTIr, I) BY
Title fi'['AliT
APRIL 1_6~ _J_9_96
EHI) I0:10
Form No. 6 fO
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FORCERTIFICATE OF OCCUPANCY
B. .For
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 i% 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.
Submit Planning Board Approval of completed site plan requirements.
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.
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 on Pre-existinR Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ..~q~.~E~.~p~ ......................
New Construction ........... Old Or Pre-existing Building ..... ~ ..........
Location of Property.. 1725 Ruth Road Mattituck
House No. Street Hamlet
Onwer or Owners of Property Martin L. Griffin
County Tax Map No 1000, Section..~ ..Block .... ! ........... Lot. 9
Subdivision M~ of Captain Kidd Estates~ Map. 1672 1~6
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval.'. .Underwriters Approval. ['~!
...........................
Planning Board Approval ........................ ~P~ I ~
Request for: Temporary Certificate ........... Final Certicate..X. ........
BLDG.
Fee Submitted: $. 100.00 'r'~,'¢l',l OF $OU'":~CL
LOf ~,,
4
~ ~PR 1 ? !0~ ~ ~or£: ,m .-MOIVUM£~Ir
FILEO IN TNE OFFICJ ~ TN~ CLEE ~ SUFFOLK
:OPT C~N~Y ON J4N I~ I~ A~ MAP ~ I~.
· 00 OS?~AN~N AV~NO~ NIV~NH~AO~
~V~Y
LO;e 196 '~PT~IN KIDD
~ ~' SOUTHOLO ~~a~~
CONSENT
TO
INSPECTION
MARTIN L. GRIFFIN ,
· the undersigned,
Owner(m) Name(~)
do(es) hereby state:
That the undersigned (is) (~) the owner(s) of the premises in the Town
of Southold located at, 1725 Ruth Road, Mattituck, New York.
· which is shown and designated on the Suffolk
County tax map as District 1000, Section 106 o Block 7 , Lot 9
That the undersigned (has) (x~mzm~k filed, or caused to be filed· an applica-
tion in the Southold Town Building Inspector's Office for the following: ~
Certificate of Occupancy ~on pre-existing building
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 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
lations of the laws, ordinances· rules or regulations of the Town of Southold.
Dated: March 27, 1996
~slgnature; ~
Martin L. Griffin (print name)
(signature)
(print name)
APR I ?
BLDG. DEPT.
TOWN OF SOUTHOLD