HomeMy WebLinkAboutZ-19535FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE-EXISTING
CERTIFICATE OF OCCUPANCY
No Z-19535 Date NOVEMBER 27, 1990
THIS CERTIFIES that the building.
Location of Property 940 PIKE STREET House No.
County Tax Map No. 1000 Section 140 Block 3
Subdivision Filed Map No.
ONE FAMILY DWELLING
MATTITUCK, NEW YORK
Street Hamlet
Lot
Lot No.
10
conforms substantially to the requirements for a Private One Family
dwelling built prior to: APRIL 9, 1957 pursuant to which
CERTIFICATE OF OCC. #Z-19535 dated NOVEMBER 27{ 1990
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 *
The certificate is issued to
of the aforesaid building.
PEARL A. MAZGULSKI
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
Inspector
Location
BUILDIi':G DEP:~Ti. LENT '
TO':~! OF SOUTHOLD, N. Y.
HOUSIi2G CODE IHSPECTION REPORT
940 PIKE STREET
MATTITUCK, NEW YORK
Subdivision
~numoeE ~ s~reeE)
M'a'o No.
~i,iunzczpa±i<y)
cot(=)
Name of 0whet(s)
PEARL A. MAZGIJLSKI
Occupancy A-!
(type)
A~mitted by: JOHN BEP4(BARDT
(owner-Eenan~)
Accompanied by: SAME
Key available
Suffolk Co. Tszc No. 140-3-10
Source of request
PEARL A. MAZGULSKi'-
Date OCT. 23,
1990
D%'UELL I MG:
Type of construction
Foundation CEMENT BLOCK
Total rooms, 1st. F1
Bat,broom(s) ! FULL BAT~
Porch, t-~pe
Breezeway
Type Heat OIL
Fireplace(s) NONE
Domestic hotwater
Other
WOOD FRAME #stories I STORY
Cellar FULL Crawl space I
2nd. FI - 5rd. FI -
Toilet room(s) -
Deck, type Patio, ty~.e CEMENT
( FJkUNT YARD)
Garage Utility room
· Warm Air FLOOR I~.ATER Hotwater --
No. Fz¢it s 2 Airconditioning
LILCO GAS .Type heater
ACCESSORY STRUCTURES:
Garage, type const.
Swimming pool
Other
NONE
Storage, type const.
Guest, type const.
VIOLATIONS:
Location
.CHAPTER 45--N.Y. STATE UNIFORM FI~E PREVENTION & BUILDING CODE
DescriDtion I-Art~.'l Sec.
Remarks-
Inspected by:
D~te of Insp.
· Time start
OCT. 23, 1990
end
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.
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 $15.00
Date ~
'~ew Construction ........... Old Or PrEexisting Building ...............
Location of Proper?~.~..~ .... ~.~(~..~...~....~.....~..~.r..~.~?~.~..~.....~..~. ............
House No. Street Hamlet
)nwer or Owners of Property ........... ; ....
]ounty Tax Map No 1000, Section ..... /.~.~. .... Block ...... .3 ....... Lot ...... Z.~. .............
lubdivision .................................... Filed Map ............ Lot ......................
'ermit No ................ Date Of Permit ................ Applicant .............................
Iealth Dept. Approval .......................... Underwriters Approval .... . .....................
Qanning Board Approval ........................
{equest for: Temporary Certificate ........... Final Certicate ...........
oO
,4 I,'E/I/ QE
M4 1- T~ lUCK
FIP. E D/STRICT
N. 25 ° 5l' '00 "~Z
GEORGE U CULLEN
NRSosG'$O"W,
55,00'
A4A T TI TUCK
FIt~E DISTRICT
~o~oo
CONSENT
TO
INSPECTION
· the undersigned.
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
of SouthotdIocatedat gCfO
)
. which is sho~ and designated on the Suffolk
County tax map as District 1000. Section . Block . Lot
That the undersigned (has) (have) filed, or caused to be filed, an applica-
tion in the Southold To~ Building 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 regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the
knowledge and understanding that any in£ormation 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 o~ the Town of Southold.
(signatuFe)-
(print name)
(signature)
(print name)