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Home My WebLink AboutZ-20355FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-20355 Date NOVEMBER 19, 1991 THIS CERTIFIES that the building Location of Property 1415 FOURTH ST~R~T House No. County Tax Map No. 1000 Section 117 Subdivision ONE FAMILY DW~.IJ.ING Street Block 7 Filed Map No. NEW SUFFOLK~ N.Y. Hamlet Lot 3 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-20355 dated NOVF_RBER 19~ 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 TWO 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 ATTAC~RD INSPECTION REPORT. Rev. 1/81 RICHARD F. MATHEWS N/A N/A " ' Inspector BUI~DI:.u DEP:M~T:.~NT T0','C,! OF SOUTHOLD, N. Y. HOUSIi~G CODE INSPECTION R~.ORT Location 1415 Fourth Street ~numoer ~ stree'~) Subdivision New Suffolk, N.Y. ~i,iunz¢ipali~y) ~[ap No. Lo~(o) Nmme of Owner(s) Occupancy. A-! Resideutial (type) Ad,mitred by: BArBArA MA'r~WS Key available Source of request RICHARD F. MA'J;~EWS OWNER ( own er- ~ enanv ) Accompanied by: SAME Suffolk Co. Tax No. ~ICHA~ F. MATH~C~S Date ! 17-7-3 NOV. 5, 1991 D~'~LLI~IG: Type of construction Foundation BRICK Total' rooms, 1st. F1 ~ · 2 WOOD F~ =storles Cellar FA~T Crawl space. FA~T 4 2nd. Fi 4 3rd. Fi Bathroom(s) 2 ~ULL Porch, type FRONT ~.NCLOSED Breezeway. Type Heat Fireplace(s) NO~ Domestic hotwater Other Deck, type Garage 'Warm Air No. ~its 2 ~S REAR EN'fKY WAY (~lUU ROOM) Toilet room(s) Patio, type Utility room Hotwater xx Aircondition~ng Type heater OFF BOII.F.R ACCESSORY STRUCTURES: Garage, type const. Swimming pool Other 2 CA~ Storage, type const. Guest, type const. VIOLATIONS: Location .CHAPTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE Descriotion I-~rt-- t Sec. Remarks: Inspected by :~.~/'/.~J~ C~/J / FISH Date of Insp. NOV. 12, 199l 'Time start 9:35 end 9:50 BUILDING DEPARTMENT NOV - 7 ,.. ~0 TOWN I~LL 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. 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 i. 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. ~ Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date /f- ~ ~.~.~ Xew Construction ........... Old Or Pre-existing Building...~ ............ t,ocation of Property .... ~.~ .~. ............. .~.e .~..~...7'.~....~.T..~..~..~..T. ...... .~...~....~.~..~'"..~...t~.. House No. Street Hamlet Onwer or Owners of Property. ~/~-f~D ~. County Tax Map No 1000, Section .... ~7 ....... Block ..... ~. ......... Lot...~. .................. Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval. Planning Board Approval .... - .................... Request for: Temporary Certificate ........... Final Certicate...~ ....... Fee Submitted: $...~p...&~..~. ................. · ............ ~ -~-.-. ~ A ] b ~ APPLICANT CONSENT TO INSPECTION NOV - 7' Owner(s) do(es) hereby state: F. N~me('s) · the undersigned, That the undersigned (is) (arc) the owner(~-) of the premises in the Town , which is shovm and desi~nnted on t}~e Suffolk · hat the undersigned (h~s) (ha~'~ filed, o~ caused to be filed, an ~pplic~- tion in the Southcld To~ Euilding Inspector's Office for the follow.g: 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 re.~ulations 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: Il -.5-7~/_..__ (signature) (print name) (silznatu re) (print name)