HomeMy WebLinkAboutZ-26341FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 26341
Date: 03/22/99
THIS CERTIFIES that the building DWELLING
Location of Property 3205 WESTPHALIA RD MATTITUCK
(HOUSE NO.) (STREET)
County Tax Map No. 473889 Section 113 Block 0013
Subdivision 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- 26341 dated MARCH 22, 1999
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 GARAGE & WOOD SHED*
(HAMLET)
Lot 022
The certificate is issued to SARA-LORrAINE MARSHALL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION ~..
Rev. 1/81
N/A
N/A
N/A
Building I ns~ctor
LOCATION: ~205 WESTPHALIA RD
SUBDIVISION:
NAME OF OWNER (S): SARA-LORRAINE MARSHALL
OCCUPANCY: SINGLE FAMILY
ADMITTED BY: RICHARD EHLERS
KEY AVAILABLE:
SOURCE OF REQUEST:
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
MATTITUCK
MAP NO.: -- LOT (S) __
SARA-LOP~RAINE MARSHALL
ACCOMPANIED BY: SAME
SUFF. CO. TAX MAP NO.: 113.-13-22
RICHARD E~LERS 3/16/99 DATE: 03/22/99
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1,Q # EXITS:
FOUNDATION: CEMENT BLOCK CELLAR: FULL CRAWL SPACE:
TOTAL ROOMS: 1ST FLR.: __~ 2ND FLR.: _.~ 3RD FLR.: ._~
BATHROOM(S): 1.0 TOILET ROOM(S): Q.~ UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: ONE GARAGE:
DOMESTIC EOTWATER: STREETGAS TYPE HEATER: GAS AIRCONDITIONING:
TYPE HEAT: STREET~SWARM AIR: HOTWATER:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIRMING POOL:
OTHER:
2 CAR WOOD STORAGE, TYPE CONST.:
GUEST, TYPE CONST.:
WOOD (OLD)
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIR~ PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART.
SEC.
INSPECTED BY:
JO~ M. BOUFIS
/
,~-,/~TE ON INSPECTION: 03/22/99
TIME START: 12:00 END: 12:20
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Co
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.
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.
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 Buildinm - $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction ........... Old Or Pre-ex~istin~ ~uilding .................
Location of Property .......................... ~ ........... · ..................................
House No. Street Hamlet
O wer orOw ersof roperty...
County Tax Map No i000, Section.. t/'~ ..Block. 1 ~ .Lot..'~'
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant .............................
Planning Board Approval.. r4/~
, .... ...............
APPLICANT
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
· the undersigned·
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at '}z,,Z'
· which is shown and designated on the Suffolk
County tax map as District 1000, Section /) ~, Block )~ , Lot ~L~
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tio~ in the Southold Town Building Inspector's Office for the following:.
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described pr(;perty, 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)