HomeMy WebLinkAboutZ-21114FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-21114
Date OCTOBER 28~ 1992
THIS CERTIFIES that the building
Location of Property 1285 FLEETWOODDRIVE
House No. Street
County Tax Map No. 1000 Section 137 Block 4
Subdivision Filed Map No.
ONE FAMILY DW~.LLING
CUTCEOGUE r N.Y.
Lot 29.1
Lot No.
Hamlet
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9r 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-21114 dated OCTOBER 28~ 1992
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 2 CAR GARAGE *
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
ETHEL HELGANS & ANO
N/A
N/A
Building Inspector
Location
Subdivision
Name of Owner(S_),L Ex~L ~ELGANS & ANO.
0¢cupa~7- . A-! RES
Admit-ted by: LAURIE HRLGANS ^ccomp.-~nJ.~d bM.- SAME
Key available
Suf£olk Co. Ta~z No. 137-04-29.1
Source of request PA~L CAMINITI, Ai:~Y· --Date
OCT. 5, 1992
D':FELL I NtG:
,Type of construction
Fo~dation CEI~NT BLOCK
Total roomS,. 1st. F1
Bathroom(s ) ONE
Porch, t~-pe REAR ENCLOSED
Breezeway_
Type Heat ELECTRIC
Firep!ace(s )' ONE
Domestic hotwater
WOOD FRAME
Cellar PARTIAL
5 2nd. Fi 3
Toilet room(s) ONE
Deck, i-yp~
Garage
·Warm. Air
No.
YES
,, .,. . 1-1/2
~S ,orles
Crawl space PARTIAL
,3rd. Fl.
Other., FRONT PORCH SCREENED IN
-.- Patio,
U ~l-- wy roo~
Hotwater
tfpe
2
Type heater
Airconditicn~ ng
LILCO
ACCESSORY STRUC~'JRES:
Garage, type coast.
Swir. ming pool
Other,.'
2 CAR
Storage, type Coast.
Guest, type coast.
V. ,_-OLATIO,>[$: .ClIAPTER 45--N.y. STATE UNIFOI~I FIIU.~ PILEVENTION & BUILDING CODE
BEACtl
AN~ 'i'~K ~AILINGS I'~FZON SHALL BE
SAFE AND SOUND CONDITION.
1242
Re..~a r',s ·
Inspected by:
BP~2104 IZ-COZ-21113
start
OCT. 9,
end
1992
Form No. 6
TOWN OF SOUTtlOLD
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 w'ith 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 f~om 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 residenc&s an~~ 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.
2. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
pre-existing land uses:
I. .Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application an~ '~ 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. 7~/: 7~-
3. 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. Cer.tificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate .of Occupancy - $5.00 over 5 years - $I0.00 -:'
· ~. .Updated Certificate of Occupancy - $50.00
5. T.emporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ~
ew ConJtruction ........... Old Or Pre-existing Building.. ~ .........
.... House No. Street Hamlet
~wer or Owners of Property .......
,unty Tax ,ap No 1000, Section.../.~.f ...... Block ...... .~. ........ Lot.
bdtviaton '
'- ~ ' Filed Map Lot
rmit No Dat~ Of Permit
~pplicant ' '
lth pt App '
a De . royal ..................
' · .... Underwriters Approval .....
arming Board Approval
]ues't fo~: Temporary Certificate .......... Final Cer
CONSE,,T
TO
INS PECT[ON
do(ca) hereby state:
That the undersigned (is) (arc) the owner(u) of the premisen in ibc To~vn
That the undersigned (hms) (h~ve) filed, or caused to be flied, gm applica-
tion in the Sou/hold To%~ Euildin.~ Insnector,s Office for the follow. E:
That the undersigned do(es) hereby give consent to the ~uilding Inspectors
of the Town of Southold to enter upon the above described proper~y, including
an.',' and all buildings located thereon, to conduct such inspections as they may
deem necessary with respect to thc aforesaid applica:ion, inc!udLn~ inspec/ioi-~s
to de[ermine that said premises comply u'ith all of the laws; ordinances, rules
and regulations of the Town cf Southold.
The undersigned, in consenting to such inspections, do(es) so ~ith the
kno::'ledge and understandin~ that any information obtained in tile conduct of
such inspections may be used as evidence in subsequent prosecutions for rio~
(siEna[utc)