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Home My WebLink AboutZ-22775FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22775 Date DECEMBER 9~ 1993 THIS CERTIFIES that the building Location of Property 525 CLARK ROAD House No. County Tax Map No. 1000 Section 51 Subdivision ONE FAMILY DW~.T,T,ING Street Block 3 Filed Map No. SOUTHOLD~ N.Y. Hamlet Lot 19 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-22775 dated DECEMBER 9~ 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 *PT~ASE SEE ATTACH~.~ INSPECTION REPORT. Rev. 1/81 FREDERICK D.J. McDONNELL N/A N/A /~ilding Inspector LOCATION: SUBDIVISION MAPLE OF OWNER (s) BUILDING DEI'AR'D~NT TOWN OF SOU~IOLD [lOUSING CODE INSPECTION REPORT 525 CLARK ROAD (number & street) MAP NO. SOIrI~IOLD, l~gW YOR~ '(municipality LOT (n) FREDERICK D.J. McDONNELL TRUSTEE OCCUPANCY A- I Res. (type) (owner-tenant) ADMI'FrED BY:. RITAHIIRPIt~ ACCO~MPANIED By:SANE KEY AVAILABLE SUFF. COl TAX MAP NO. 1000-51-03-19 NO¥. 23, SOU~C~ OF REQUEST: GARY FLAI~R oLSEN, ATTY DATE: DWELLING: l~f~E OF CONSTRUCTION FOUNDATION TOTAL ROOMS: IST FLR. BATHROOM (s) ONE PORCH TYPE BREEZEWAY D0~STIC HO~¢ATER .YES TYPE IIEAT OIL O~IER: CEHENT 'BLOCK SIDE ENCLOSED WOOD FRAM~ ORE 2ND FLR. TOILET ROOM (s) DECK,· TYPE FIREPlaCE NONE TYPE HEATER WARM AIR { STORIES ONE ~ EXITS 2 CELLAR FULL CRAWL SPACE 3RD FLR. UTILITY ROOM PATIO, TYPE CAI{AGE AIRCONDITIONING HO~{ATER~ ACCESSORY STRUCT~I~ES: CARAGE, T~PE OF cONST. SOIM)tlNG POOL OileR: NONE STORAGE, TYPE CONST. , GUEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE L~CATION ', DESCRIPTION ART. SEC. REMARKS: INSPECTED GA~Y DATE ON INSPECTION DECEMBER 7,~ 1993 TIME START 9:35 am ENIJ 9:50 am FORM NO, 6 TOWN OF SOUTHOLD . Building Dnpartmunt Town Hall Southoldo N.Y. 11971 765- 1802. APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted -- um.mmma to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sume¥ of property witl~ accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-{S-9 form or equal}. 3. Approval of electrical instullation from Board of Fire UnrJerwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed she plan requirements where :-,pplicab!e. · For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land u~es: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner' as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premix, es, or other pertinent informa- tion required to prepare a certificate. C. Fees: h Certificate of occupancy $25;00 -- ]tUSlNE$S $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.00 3. Copy of certificate of occupancy $ 5*'00, over 5 years $10.00 4.Vacant [,and c.g. $·20.00 Nov. 23, 1993 5. U.odatocl C · O. $" 5 0.0 0 Date .......................... Newcons t,ruct,ion Old or Pre-existing Building X Vacant Land 525 Clark Road, Sduthold, N.Y. Location of Property Hou~ No. Sr[~ur Hamlsr Owner or Owners of Property Frederick D., J.; McDonnell County Tax Map No, 1000 Section Q51 ,QQ ......... Block . .Q~.Q0, ........ Lot. ,0,],9,..0,0,0, ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ............ ~ .Planning Boa~roval .......... Fee Submitted $...~qq,qq'. ................... ~ Construction on above de~ribed building and permitr~~~/~ al ~ ic hie code~ and regulations. ~ hcant .... ~.~..~ ............... pp ............. ....... Ga~y F~anne~ 0]sen, Esq. Re~,lO.lo,~8 P. 0. Box 706 ~,~?~b~ Cutchogue, NY 11935 G CONSENT TO INSPECTION Ga,r,,y Flanner 01sen ~ Owner(s) 'Nam'e(s) do(es) hereby state: · the undersigned, That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at 525 Clark Road, Southold · which is shown and designated on the Suffolk County tax map as District 1000, Section 051.00 ~ 'Black 03.00 · Lot 019.000 . That the undersigned (has) (have) filed· 'or caused to be filed, an applica- tion in"~l~ Southold Town Butlcling lnspeu~ .o or. tl~,o to,, .h~ fr~llnwin~: One story frame dwelling with enclosed porch That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property· including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, £nc!uding inspections to determine that said premises comply with all of ."he laws· ordinances, rules and regulations of the Town.of Southold. The undersigned, in consenting to such inspections, dc(es) so wi~h the knowledge and understandin~ that any information obtained '_n /concluder of such inspections may be used as evidence in subsequent pr/ecuttons for vic- , / lations of the laws, ordinances, rules or regulations y?_"'~o~Southeld. Dated: November 23,, 1.9,,.93 , _,//,~.~-~./,- ~ - ~' ~(s~gnature) 6ary Flanner Olsen (print name) (signature) '(print name) 2 · 'TOWN 0~: SOUTHO! : 44 ' ~"?:,' PI::tGE . 004 CLARK RD. /~- EOfl" OF AIPH. ~lOAO , ' ,S20*SG IQ ~ 50.00 ....... . I "'"' -- ': '"" I ~ I ~ '"' ':'~:' ""' ':'" 'l N 2:1' ~39~ 50= W ~ 50.00' .. ":. . KAMP$(~L. 440:~ p. 45?),FORMERLY SAMUEL. 1DA¥15 SURVEY'OF PROPERTY A'r SOUTHOLO". TOWN OF SOUTHOLD_: , . . . COUNTY OF' SUFFOLKs, N:,y.'. .... MAP OF ~ ...... .....i., ...._ BLOCK: -- LoT: - "'?,-.-,' ANDRIANI CERTIFIED TO; FIDELITY NATIONAL TITLE IN.~UR.CO. OF N.Y. OMNI ABSTRACT CORP. KYRIACO$ ARGY R'IDE S SCALE: ARGYRI OES .u,=.,o...,. o,,.,., ,o Thomas 'Lieurse DTARING A LICENSED LAND SURVI~'Y0fl'S 5F..AL IS A VIOLATION OF S~CTION 7209. SDB-OiVtS~N 2. OF THE NEW YORK SIATE EI)LX~AI10. LAW. Licensed Professional Land Surveyor. ONLY COP1~$ FROM 'THE ORIGINAL OF THiS SUflYEY MARKED WITH AN O~I~INAL 0¢ THE LAND SURVEYORS INKED ZEAL OR ': · HIS EMBOS~0.~AL SHAll BE CON~OEIt~D TO BE VALID TRUE '. .. C~RTIFICATIONS INO~CATEO I. EREON SIGNIFY THAT THIS SURVTY WAg PREPAREO IN ACCO~N~ WITH mE EXISTING coo~ 0; ~,*CT~ ~ LAm SUR~YS A0~'~0 ,Y mE ~W .~'~', ",-?.'- "~:7..~',,*,'~".'"'. Jer,cho, NY 117,53 YORK STATE A$$QClATIQfd OF ~ESSIONAL LAND SU~YEY. ,,'-a~%,'?:[~?'' . "{;~,"~4,.~'~....' oP.s. SAIO CEHTF~,TI0~S 5,ALL RUN OfdLY TO IH~ PEP~ON DiE 11TLE COMPANY. GOV~flNMEHTAL AGENCY AND LENDiHG w, A/.':/}~.,""~'~1~ I :~. ]~ ' ' '" ' '. - II~111Ul'IONLISTEDHEIEON. AND10 THE ASSIG~dEE$ OF THE ~../-*.// ~.,|t~.=~'~,~'.. l~/~"~= ' ' -' " LENDfl~ II~TITLITK3N. ~RTIFICATIONS 41~ l~OT TRANS- ~Z'-'.j~/ ~J,: .i~.O ._~.. · . ' . ..'. ~ER~ISLE 10 ADOfl~ONAL INSTITUTIONS ~ SUBSEQUENT ~'.~r/~/._,,,. ~'~~ ~.. ...' '- · o,~<. . ~:~.# ;~..:. · ..... · Y.-,..~ ~ ~I,,~ -..~.~ .-y, /1, ~1 :,~l,~- .' .~.';. · . '.