HomeMy WebLinkAboutZ-28180FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 28180
Date: 01/28/02
THIS CERTIFIES that the building DWELLING & ACCESSORY
Location of Property 1265 PARK AVE MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 123 Block 0002 Lot 028
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 u~RTIFICATH OF
OCCUPANCY NUMBER Z- 28180 ~ted JANUARY 28, 2002
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 CONCRETE PATIO AAID ACCESSORY TWO CAR GARAGE*
The certificate is issued to JOSEPHINE E MISCIOSCIA
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPAN~IWENTOF}IEALTHAPPROV~J~
ELECT~IC3%L CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~u
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
I~T I ON:
SUBDI~SION:
1265 PARK AVE
NAME OF OWNER (S): JOSEPHINE E MISCIOSCIA
OCCUPANCY: SINGLE FAMILY
ADMI-l-r~u BY: CD2qL AUSTIN
SOURCE OF REQUEST:
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
MATTITUCK
MAP NO.: LOT (S)
JOSEPHINE E MISCIOSCIA
ACCOMP~/~IED BY: SAME
SUFF. CO. TAX MAP NO.: 123,-2-28
DAW: Ol/~8/o2
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 # EXITS: 2
FOUNDATION: CEMENT BLOCK CRI.I~%R: PART CRAWL SPACE: PART
TOTAL ROO~S: 1ST FLR.: 5 2ND FLR.: 0 3RD FLR.: 0
BA'r~ROOM (S): 1.0 ~)I~ HOO~(S): 0.0 UTILIT"f ROOM(S):
PORC~ TYPE: DECK TYPE: PATIO TYPE:
BP. EEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTWAT~: YES ~"fPE HEATER: OIL ;~IRCONDITIONIN~:
CONCRETE'
ACCESSORY STRUCTURES:
TWO C~LR WOOD FRAME STORAGE, ~PE CONST.:
GUEST, TYPE CONST.:
VIOIu%TIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART, SEC.
P~: BP#1547 ADDITION COZ1337
INSPEt-£~U BY:
DATE ON INSPECTION: 01/18/02
TIME START: 10:30AM END: 10:50AM
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 Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
3.
4.
5.
B.. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings
1. Accurate survey of property showing all property lines, streets, building and unns.
features.
2. A properly completed application and a consent to inspect signed by the applicant
is denied, the Building Inspector shall state the reasons therefor in writing to the ~
C. Fees
1.
3.
4.
5.
topographic features.
Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
Approval of electrical installation from Board of Fire Underwriters.
Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
Commercial building, industrial building, .multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building, re. Ii \!! ~ [~
· , · n r,~ ~
Submit Planning Board Approval of completed site plan requirements. ,~h ? [~ (i~ , q ..... "~_,~: !~I
n~ ! Prgllll[s~i~ ~ ~SeS~
topog,' c
New Construction:
Location of Property:
or Owners of Property: ,~J"~.~D, ~i/l
OWner
Suffolk County Tax Map No 1000, Section
Subdivision
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
Photocopy of Certificate of Occupancy - $ 0.25
Updated Certificate of Occupancy - $50.00
Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. ,~~)/ II, 2o0/
Old or Pre-existing Building: l,''/ (check one)
House No. Street Hamlet
Permit No.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
c
Date of Permit.
'~'~'~ a.t'o .g Ct'a_
Block ag- Lot ~q ~
Filed Map. Lot:
Applicant:
Underwriters Approval:
Final Certificate: ~-"'_d (check one)
IL) o~C ~_~i~ar~tt Signature
CONSENT
TO
INSPECTION
~-~/~/~l '-~T/~'S ~-J'O ~C~/~ the undersigned,
O~er(s) Name(s) '
do(es) hereby state:
That the unders~ned ~ (are) the o~r(s) of lhe premises ~ the To~
of Southold located at ]~5. Pa~ MV~ ?~,'.~, ~
, 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 ~iled, an applica-
tion in the Southold To~ Building Inspector's Office for the [ollow~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. or the laws, ordinances,.~rules
and regulations o£ 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
lations of the laws, ordinances, rules or regulations of the Town of Southold.
Dated: 1/1'/07- · . AJi>"~(~kJJ~
, ' (signature~ - -
,, (print name)
(signature)
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