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Home My WebLink AboutZ-20122FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z20122 Date JTJLy 30r 1991 THIS CERTIFIES that the buildin~ SEASONAL ONE FAMILY DW~.T~.ING Location of Property 2545 WEST CRw~.KAVE. CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 110 Block 05 Lot 01 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for a private one family dwelling built prior to APRIL 9~ 1957 pursuant to which Certificate of Occupancy Z20122 dated July 30, 1991 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 SEASONAL DWELLING. *** The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED WILP~.T.M & CORDRLIA HAYSOM *** SEE INSPECTION REPORT Rev. 1/81 BuldingInspector Location Subdivision N~me of Owner(s) BUI~DI:.G DEP:LqT>LZNT ~-O.aI OF SOUTIIOLD, N. Y. HOUSI[;G CODE IHSFECTION REPORT 2545 WEST CREEK AVE. CUTCHOGUE (numoer ~ sTreev) Map No. WILHELM & CORDELA HAYSOM (i4unzcipa±i5y) Lot( ) Occupancy A~mitted by: Key available Source of request A-I (type) GARY OLSEN WILHELM HAYSOM OWNER ( owner- venanz Accompanied by: SAME Suffolk Co. Tax No. 110-5-1 Date Jq3LY 30, 1991 ~, r~T T,% · D .... L_.IG. Type of construction WOOD FRAME Foundation CEMENT BLOCK Cellar FULL Total rooms, 1st. F1 3 2nd. F1 -- Bathroom(s) ! F,LL BATH Toilet room(s) __ Porch, type SCREEN Deck, type Patio, Breezeway-- Garage -- Utility room Type Heat NO ~.AT 'Warm Air -- Hotwater -- Fireplace(s) ONE No. Domestic hotwater YES Other ~ ENTRY WAY #stories Crawl space,-- 3rd. F1 -- type_ Exits 2 Airconditioning .Type heater ELECTRIC ONE ACCESSORY STRUCTURES: NONE Garage, type const. Swim, ming poo! 0 ~ner Storage, type const. Guest, type const. VIOLATIOMS: Location ~ D__escri?___mtion -- .CP~PTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUTt.DING CODE I-A~rt-.'l Sec. Im42.5 (c) I ~RA~. F t ~242.5 (E) Remarks: oo To ~ ~ ~.~s. Date of Insp. 7/3o/91 'Time start I0:10 end 10:30 TOWN OF '~OUT~IOLD I FORM NO. 6 TOWN OF SOUTHOLD · Building Department Town Hall Southold, N.Y. 11971 765- [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor with 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, a certificate of Code compliance from the Architect or Eng neet responsible for 5. Submit Planning Board approval of completed site p an requirements where applicable, the building. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p=operty showing all property lines, streets, buildings and unusual natural or topograph ic featu res. 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: 1. Certificate of occupancy $25:00 -- 5USZNESS $$0.00 2. Certificate of occupancy on pre-existing dwelling $ _50.00 3. CopY of certificate of occupancy $'§,'00, over _5 years $10 00 4.Vacant Land C.O. $ '20.00 ' 5.Updated C.O. $"50.00 Date.. '~.~ %-~..~.~.~ New C°ns truc ~'i°n ...... Old or Pre-existing BuiJding '~ ............ Vacant Land ............. Location of Property . .~..,~.~.~..D~. ~. £.~.'¢~-~ .L,,...~..%,'.L_. C .¥,."~ House No. · .... ? .............. ~. e.~,¥~'L. Owner or Owners of Property ~'~ .~. .................. .v~ .... ...... ~ ~_ & ~ ,.~ County Map No. ,000 Sect,o. .... B,ock .... Lot l ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ................... · · ....Labor Dept· Approval ........................ Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate .................... ~1 Certificate . ................... C°nstructi°n ~n ab°ve describ~p;; i;;~g anCO°des and renu lati°n$' .... '" <'':' ...... ................. CUTCHOGUE, L.I., N.Y. 11935 ~,,~.~ C.O. ~. J2, o I ,,%2... CONSENT TO INSPECTION , F. Haysom do(es) hereby state: · the undersigned· That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at Westcreel< Avenue, Cutchogue, NY · which is shown and designated on the Suffolk County tax map as District I000, Section 110 , Block 5 , Lot i That the undersigned (has) (have) filed, ~or caused to be filed, an applica- tion in'"ll~...Southold Town BUllaing lnspe~;~.,, .o or.~.o to,. +h. tnllmvin~: ! .story i 1/2 fami y/resloence with attached porch 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 vio- lations of the laws· ordinances, rules or regulations of the Town of Southold. Dated: July , 1991 Wi lhelm (signature) Cordelia (print name) 0