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Home My WebLink AboutZ-22535FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22535 Date THIS CERTIFIES that the buildin~ Location of Property 19100 MAIN ROAD House No. County Tax Map No. 1000 Section 115 Subdivision AUGUST 20~ 1993 ONE FAMILY DW~.LLING Street Block 7 Filed Map No. MATTITUCK~ N.Y. Hamlet Lot 14 Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9~ 1957 pursuant to which CERTIFICATE OF OCCUPANCY UMBER Z-22535 dated AUGUST 20~ 1993 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 (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACPr~.D INSPECTION REPORT. Rev. 1/81 JACQUELINE K. MITC~.LT. uil~'ing Inspector BUILDING DEPARTMENT TOWN OF SOUTIIOLD HOUSING CODE INSPECTION REPORT LOCATION: SUBDIVISION NAME OF OWNER (s) 19100 )fAIN ROAD (number & street) JACQUELINE Ko HITCHELL HAP NO. MATTITUCK, N.Y. (municipality LOT (s) OCCUPANCY A-i P~S. (type) · O~R (owner-tenant) ADMI'i-rED BY:. JACQUELINE K. MITCItI~LL KEY AVAILABLE SOUKCE OF REQUEST: JACQUELINE MITCHI~LL ACCOI~fPANIED BY: SAI~ SUFF. CO. TAX HAP NO. 1000-115-07-14 DATE: AUGUST 16, 1993 DNELLING: TYFE OF CONSTRUCTION FOUNDATION BRICK WOOD FP.A~E TOTAL ROOHS: IST FLR. 4 BATHROOM (s) 2 PORCH TYPEWP-AP ARODND COVERED BREEZEWAY DOMESTIC H0~ATER YES. TYPE HEAT LILCO - GAS OTHER: MUD.ROO~ ~ STORIES 2 # EXITS CELLAR PARTIAL CRAWL SPACE 2ND FLR. 3 3RD FLR. TOILET ROOM (s) UTILITY ROOM DECK,'TYPE PATIO, TYPE FIREPLACE GARAGE TYPE HEATER LILCO AIRCONDITIONING WARM AIR XX HOTWATER ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. S~IMMING POOL OTHER: STORAGE, TYPE CONST. · GUEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. REAR ROOF ROOFS SHALL BE MAINTAINED IN A WATERTIGHT CONDITION. NYCRR ) (B) IST FLOOR pART. 1242.5(di · GARY .,~ ~'~SH ' DATE ON INSPECTION AUGUST 17, 1993 TIME START ENI~ Form No. 6 TOWN OF SOUTtlOLD 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/lO~of l%·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.. B. For existing buildings (prior to April ~9, 1957) non-conforming uses, or buildings and lpre-exlstlng land uses: I. Accurate survey of property showing all property lines, streets, building and unusu~ natural or topographic features. 2.. A properly completed ap~ation and a consent to inspect signed by the aD licant If a Certificate of Occupanc~ 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 ~uilding - $100.00 3. ·Copy of Certificate of Occupancy - $---~.00 ove~r ye~r~ ] $~.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New·Construction ........... Old Or Pre-existing Building...~ ............ Location of Property...~.~.'J..~..~. ........ ~i~...~.~. ~. ~~ I l House No. Street ........ 1Hamlet ''' Onwer or Owners of Property .... 7.~.~~-~%.~_~...~.,..~ l ................. County Tax Map No I000. Section,,~{.~...~...Block...~Z,~.~....Lot..~.,~O.~' ...... Subdivision ...... .Filed Map ..... Lot ............. Permit No ................ Date Of Permit ............. ...Applicant ...... ............ · .... Health Dept. Approval .......................... Underwriters Approval ................ f ........ Planning Board Approval ............. ~ ....... ~... Request for: Temporary Certificate ........... Final Cert~cate Fee Submitted: $. ~C)~).~ I RE)Al} ( ^L Y.S. RTC. N. 89°03'00"F. 68.8 ~ .30' ~ ., 130 - i ~ 150.10' N. 87~'39'20"W. LOT 8 EXHIBIT A :.. RUTH ENGLE ', ',AT MATTITUCK , :,TOWN OF 50UTHOLD " $UFFOLK COUNTY, :SCALE ~ 1"=40~ AUG. 16, 1971 AUG. 3/ ~ 1971 GUARANTEED TO' ' -' SECURITy TITLE 8~ GUARANTY COMPANY SOUTHOLD SAVINGS BANK .. RUTH E,¥GLE ~ ~ LAND RIVERHEAD Owner(s) Name(s)'' do(es) hereby state: CONSENT TO INS PEC'FION · the undersigned, That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at ,!~t(h~) ~ [~'~ ~A ~[_~L~C~ ' · which is shown and desifnated on the Suffolk County tax map as District 1000, Section [ [~ , Block ~)'-/ , Lot (~(C~ That the undersigned (has) (have) filed· 'or caused to be filed, an applica- tion in the Southold Tox~m 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 property, including any and all buildings located thereon· to conduct such inspections as they may deem necessary with respect t'o 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. 13 (signature) (print name)