HomeMy WebLinkAboutZ-21078FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-21078
Date OCTOBER 9~ 1992
THIS CERTIFIES that the buildin~ ONE FAMILY DWETJ.YNG
Location of Property 575 MILL CREEK DRIVE SOUTHOLDr N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 135 Block 3 Lot 33
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9r 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-21078 dated OCTOBER 9~ 1992
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 DWR. LLING *
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTYDEPARTMENT OF HEALTHAPPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PL~SE SEE ATTACPr~ INSPECTION REPORT.
Rev. 1/81
SBr.r~ McGUIRE & ORS.
TO'.',~I C~ oCU~,~O~D, N. Y.
HGUSi::C CCCE IUS?ECTION RE?CRT
Location
Subdivision
575 MILL CREEK DRIVE
SOlrrltOLD, NE~/ YORK
N~.~e of Owner(S_),. SALLY McGUIRE & ORS.
Occupant7.,
Ad~nitt cd by:
A-I RES.
PAUL HEt.'tq~RNAN
O~NKR
~ O~.'I fl (~E- C0~2~)
Accomp~ni ed by: SAME
Key available
Suffolk Co. Tszc bio. 135-03-33
Source of request.
PAUL REFFERNAN
Date
10/8/92
DE~ELLING:
,Type of construction
Foundation CEMENT BLOCK
Total roomS, 1st. F1
Bathroom(s ) ONE
Porch, t~-pe
Breezeway__
Deck,
Garage
MOOD FRAME ~ = · ONE
?S ~orles
Cellar ,. Crawl soace Iix
2nd. Fl._. .Std. Fl. :-
Toilet room(s)
..- Patio, typeSLATE
U~I ~ ~
Type Heat OIL ' Warm. Air ~ Hot:,/ater
Fireplace(s) ONE No. Fzcits 2 Airconditicnin~
Dcmestic hot:Tater YES' Tyzpe he_~__ ELECTRIC
Other_ ON GRADE SLATE PATIO "SEE SUR~EY" -
Garage, type const.. Storage, type Const.
Swim.ming pool Guest, type const.
Other
yiOLATIO[,!S:
_~cation [
.CIIAPTER 45--N.y. STATE UNIFOI~I FII~{ PREVENTION & BUILDING CODE
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Rems rks:
Inspected by:
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Date of Insp. OCT. 8, 1992
· Time start 9:30 end 9:45 AM
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
': APPLICATION FOR. CERTIFICATE OF OCCUPANCY
A. 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:
I. 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 f~om 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 an~~ 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-exzstzng" land uses:
1. .Accurate surv_e.x Of_pro ert showing
_. ___ _o_~ y all property lines, streets, building and
unusual natural or topographic' features.
2. A properly completed application and '~ consent to inspect signed by the applicant.
If a Certificate of O~cupancy is ~denied, t~uilding Inspector shall state the
reasons~therefor in writing to the applicant.
: · Fees
I. 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.
~ Cer.tificate of Occupancy on Pre-existing Building - i00 0
· 3. Copy of Certificate of Occu~-~-. ---~= ~- . ~_.00~__
4 . ' ~ ,,~ - ~o.uu over ~ years - 10.
· .Updated Certzficate of Occupancy - $50.00 $ 00
5. Temporary Certificate of Occupancy - Residential $15 00, Commercial $15.00
Date .......
.... House No. Street [ ' " ' ..........
nwer or Owners of Property ...... . ....... .
~unty Tax Map No 1000, SectionZ] .~. ....... Block.~ .... Lot~.~ ..
~bdiviaion ' '
·" ' Filed Map Lot
rmit No Date' Of Permit ..~... Applicant
alth Dept Approval
' ' ......................... Underwriters Approval·.. . ...................
arming Board Approval
quest for: Temporary Certificate ........... Final Certicate..~. ........
(Dwner t s) Namcl:;)
do(es) hereby state:
CONSE?,'T
TO
INS PEC'FION
__ , thr: undcr.~i~jn:d,
That the undersigned (,_is)(arc)the owaer(s) of thc prcmi$~[n thc Town
~. which is ~hown and designated on the Suffolk
County tax map as District I00O, Section ~lock Lot
That tile undersigned (has) (~ filed, or caused ~o be filed, an applica-
tion in the Southcld To%%~ Euildin~ Inspector,s Office for thc follow~a:
That the undersi.~ned do(es) hereby give consent to the ]3uildin~ Inspectors
of the Town of Southold to enter upon the above described property, includin~
an.,,, and all buildings located thereon, to conduct such inspections as they
deem necessary wi~h respect to the aforesaid applicaiion, inc!udLn% inspec:icns
to determine that said Premises comply with all of the laws; ordinances, rules
and reKulations of the Town cf Southold.
The undersigned, in consentin~ to such ~spections, do(es) so %%4th the
knowledge and undersiandin~ that any ~for~ation obtained in the conduct of
such inspections may be used as evidence in subsequent prosecutions for
Iations of the laws, ordinances,
. rules or repletions f ~he Town o~S uthold.
(p~in~ name)
(s i~]nlLlrc) --
(prin[ name)
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