HomeMy WebLinkAboutZ-20422FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-20422
THIS CERTIFIES that the bui
Date DECEMBER 20, 1991
ONE FAMILY DWELLING
Location of Property 11185 MAIN BAYVIEW ROAD SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 88 Block 1 Lot 8
Subdivis
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-20422 dated DECEMBER 20, 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 DWELLING WITH ACCESSORY ONE CAR GARAGE, ACCESSORY
CONCRETE BUILDING 40' x 80' & WOOD FRAME SHED 10' x 16'
The certificate is issued to PETER & MARY JACQUES
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
-"Building Inspector
Rev. 1/81
BUILDI"G DEPA T:•1E JT
T0:•4i1 OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location 11185 MAIN BAYVIEW ROAD SOUTHOLD, NEW YORK
�numoer & street) i,iunicipaiity)
Subdivision Map No. Lots)
Name of Owners) PETER & MARY JACQUES
Occupancy A-1 RES.
(type) (owner -tenant)
Admitted by: PETER JACQUES Accompanied by: SAME
Key available Suffolk Co. Tax No. 88-1-8
Source of request PETER JACQUES Date NOV. 19, 1991
DWE LI'HG :
Type of construction WOOD FRAME I I !t
r, stories 2 STORY
Foundation STONE & BRICK Cellar PARTIAL Crawl space
Total rooms, 1st. Fl 6 2nd. F1 5 3rd. F1
Bathroom(s) 2 FULL BATH. Toilet room(s)
Porch, type SIDE ENCLOSED Deck, type Patio, type
Breezeway Garage Utility room
Type Heat OIL 'alarm Air II Hotwater
Fireplaces) ONE No. Exits 3 A-irconditioning
Domestic hotwater YES Type heater OIL
Other
ACCESSORY STRUCTURES: ]-CONCRETE BLDG.40x8O
Garage, type const. ]CAR WOOD 2•gggD (WOOD FRAME)
Storage, type const. 0%16
Swimming pool Guest, type const.
Other CONCRETE BLOCK FOUNDATION (BELOW GRADE) 6 ACCESSORY WINDMILL IN REAR YARD.
VIOLATIONS: CHAPTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE s
Remarks: BP 1873Z -CO Z-842 ISSUED
Inspected by: Date of Insp. DEC. 17, 1991
Y J. FISH Time start 10:00 end 10:30
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
:. 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 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.
3�. 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 Occupancy 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 $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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date..1`..�..q !...........................
New Construction........... Old Or Pre-existing Building. ✓.
Location of Property. � �) � 5...... .1.2 i �. �? 2.Y V 1 Q W U �
House No. T Street `A' lHamlet
Onwer or Owners of Property..... �. .� Y.. v. a �� �.� �. S.. !� ..4� i.T.i .- �!/t . .................
County Tax Map No 1000, Section.... ....... Block....I........... Lot...4..................
Subdivision....................................Filed Map ............ Lot ......................
Permit No................Date Of Permit ................ Applicant .............................
Health Dept. Approval..........................Underwriters Approval.........................
Planning Board Approval ........................
Request for: Temporary Certificate........... Final Certicate...........
Pee Submitted: $:�.... Ci .....................
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I
ICTE
Vwner(s) Namc(s)
do(es) hereby state:
CONSENT
TO
INS PCCTION
es 4 wtr6-
the undersigned,
That the undersigned (is) (are) the owners) of the premises in the Town
Of Southold located at t �S_ r�,q,N �3�rviEW RD 50 U7`if(/CC n A/ Y
which is show -n and desi.c�nated on the Suffolk
County tam map as District 1000, Section F92 Block Lot
That the undersigned (has) (have) filed, or caused to be filed, an applica-
tion in the Southcld Town Building Inspector's Office for the following:
T141 USC 6v� L _ CI.
GF rP95-_1 A1<2 /N49
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 cf 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:
(sign ure)
A TER -c/fl e.C�, u P s
(print name)
(siaA deurCIC
/"/, d" T/A- c4 u r= 5
(print name)
OF SOUTHOLD ROPERTY RECORD ` C�►RD
OWNER
STREET
VILLAGE
DISTRICT
SUB. LOT r
FORMER OW4fR
N
f
E
ACREAGE
S v
W ,- n
TYPE OF BUILDING
.2ES.7
SEAS.
VL.
FARM
COMM.
IND.
I
CB. I MISC.
LAND
IMP.
TOTAL
DATE
REMARKS
3 L
W V
to too
_dd
32ao
3!9O D
T 9 O
3 /2 3
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% c? o O V1��S
%��
KGs-� ! / 3 /�? y
.S' 3 3 to, J ^ -r+ H
AGE
BUILDING CONDITION
NEW
NORMAL
BELOW
ABOVE
O A 2-9
Farm
Acre
Value Per Acre
Value
Tillable 1
Tillable 2
>Tillablo,, 3
Woodland
Swampland
k Brushland
House Plot
Total
. >�•
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t(� :� dry «»s.��« � ...y
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TO'.id CF CCU-: CLD, N-
F.OUSI;:G CCL..
--1777ORT
Loca ticn
Subdivision
Man No . Lots )
Name of 0,:lner(s)
Occupa^cY
1,� -Ac,.cmp Hied
r►c�:1; •_� zd by.:
Suffolk Co.
Key available
V'L" -�- K,
Source of request
Type of construction
by -
Tax No. d -%'e
Date �� /� 91
lstories
n Fes. y ,u --k-
Crawl space
Foundatio
Total rooms,
1st. Fl L 2nd. F1 3rd. F1
_
Bathrooms) Toilet room(s)
Deck, type — Patio, type
Porch, type _
Breezeway Garage Utility room
Tyne Heat ?[arm Air r/ HotT;later
Fireplace (s) o No . Exits 3 Aircor_di tion=.nom
Domestic he twater Type heater
Other
ACCESSC�Y STVUCTUPIES : CJ
1, torzge, type const.
- Garage, type const.
cool Gues y, Ytye const.
Seri,."11_ I_
Other
VIOLA?'IGiiS : CHAPTER 45--N.Y. STATE UNIFOIZM FIRE PREVENTION & BUILDING CODE
Art. Sec.
Lncaticn Desc"=nticn I
Remarks:
3 �
I
,t, Date of Insp._�11 `
Inspected by: nC�
—
• •Time start /0:0 e d�