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Home My WebLink AboutZ-28984FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 28984 Date: 10/10/02 THIS CERTIFIES that the building DWELLING /LND ACCESSORY Location of Property 1265 BAY AVENUE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 143 Block 0005 Lot 001 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 CERTIFICA~ OF OCCUPANCY I~t~4BER Z- 28984 dated OCTOBER 10, 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 REA~R ENCLOSED ENTRYWAY A_ND ACCESSORY ONE CAR GDS~AGE. * The certificate is issued to LILLIAN DICKERSON (OWNER) of the aforesaid building. SUFFOLK COUI~I"fDEPARTMKNTOF~ALTHAPPROVAL ELECTRICAL CERTIFICATE NO. PLE~4BE~S CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A //ut/zed Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 1265 BAY AVENUE SUBDI'~r~SION: ~AME OF OW~ER (S): LILLIAN DICKERSON OCCUPANCY: SINGLE FAMILY AD~l'~-r~u HY: LILLIAN DICKERSON MATTITUCK MAP NO.: LOT (S) LILLIAN DICKERSON ACCOMPANIED BY: SAME KEY AVAILABLE: S~IFF. CO. T~X ~ NO.: 143,-5-1 SODRCE OF REQUEST: LILLIAN DICKERSON DATE: 10/90/02 DWELLING: T~PE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 ~ EXITS: 2 FOUndATION: CEMENT & BRICK C~LI~%H: PART. CRAWL SPACE: TOTAL ROOMS: 1STFI~H.: --4 2ND FIuH.: __0 3RD FI~.: ~0 BA'£~O(~(S): 1.0 TOIL~TRO~(S): 0.0 UTILITY ROO~(S): PORCH TYPE: FRONT ENCLOSED DECK TYPE: PATIO TYPE: BREEZ~Y: FIREPLACE: G;~D3%GE: D(~w~ESTIC H(YI~FATER: X TYPE HEA'r~: LIPA GAS AIECONDITIONING: TU/pE HFS%T: LIPA GAS W~/~A~IR: FLOOR HEATER EO~FATER: REAR ENCLOSED ENTRYWAY ACCESSORY STRUCTURES: GAP~GE, T"fPE OF CONST.: ONE CAR WOOD FR3LME STOP,~/~E, TYPE CONST.: SWI~O~ING POO~.: G~O'~ST, TYPE CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. INSPEt-A'~ BY: DATE ON INSPECTION: 10/03/02 TI~E START: 10:00AM ]~D: 10:20AM 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: Ao Ce 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) hon-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 consent to inspect signed by the applicant. Ifa 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. Certificate ofOccupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 D~te. Old or Pre-existing Building: ~ Street New Construction: Location of Property: House No. Owner or Owners of Property: Suffolk County Tax Map No I000, Section Block Filed Map. Applicant: Underwriters Approval: Final Certificate: Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Date of Permit. (check one), /crc/r-ua/(_ Hamlet Lot - ~ ~ ] Lot: (check one) Applicant Signature 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~ISULATION [ ] FRAMING [ ~'/FINAL~-~ ~ [ ] FIREPLACE & CHIMNEY DATE INSPECTOR CONSENT TO INSPECTION Owner(s)Name(s) , the undersigned, do(es) hereby state: That the undersigned (is),.(are) the owner(s) of the premises in the Town of Southold, located at ! which is shown and designated on the Suffolk County Tax Map as District 1000, Section ., Block ., Lot That the undersigned (has) (have) filed, or cause to be filed, an application 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 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 information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: (Signature) (Print Name) (Signature) (Print Name)