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Home My WebLink AboutZ-19695FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-19695 Date JANUARY 30~ 1991 THIS CERTIFIES that the building. Location of Property 2420 BRAY AVENUE House No. County Tax Map No. 1000 Section 126 Subdivision ONE FAMILY D~J,LING LAUREL~ NEW YORK Street Hamlet Block i0 Lot 3 Filed Map No. Lot No. conforms substantially to the requirements for a Private One Family Dwelling built prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCC. #Z-19695 dated JANUARY 30~ 1991 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 ATTACHED ONE CAR GARAGE * The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 JAMES E. & LYNN B. OLSEN Location BUI~DI..G DEPARTi.LENT . T0:'~! OF SOUTHOLD, N. Y. HOUSI!~G CODE IHSPECTION REPORT 2420 BRAY AVE. LAUREL, N.Y. ~numoer ~ snree~) Subdivision No. not(s) Name of Owner(s) JAMES & LYNN B. OLSEN Occupancy A~mitted by: A-I [type) JAMES OLSEN OWNER ( owner- ~ enan< ) Accompanied by: Key ~vailable Suffolk Co. Tax No. |26-|0-3 Source 0£ request JAMES OLSEN Date Jan. I1, 1991 D%'~LL!~: Type of construction Foundation CEMENT BLOCK Total rooms, lsto F1 7 Bathroom(s) 2 FULL Porch, type Breezeway. Type Heat OIL Fireplace(s) NO Domestic hotwater Other WOOD FRAME Cellar !/2 2nd. FI - - Toilet room(s) Deck, type Garage ICAR '~a~m Air XX No. ~¢its 2 YES #stories ONE 1/2 Crawl space 3rd. Fi - - Patio, type CEMENT Utility room .Hotwater Airconditioning ~ype heat'er LILCO CAS ACCESSORY STRUCTURES: Garage, type const. Swi.~ning pool Other NONE Storage, type const. Guest, type const. VIOLATIONS: Lncation .C~WTER 45--N.Y. STATE UNIFORM FI~d~ PREVENTION & BUILDING CODE Description } Art. [ Sec. Remarks: Inspected by: GA~)~/J. FISH Date of Insp. JAN. 22~ 199~ 'Time start 9:30 end 9:50 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 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 2/10 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) non-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 a consent to inspect signed by the applicant. If a Certificate of Occupancy is 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. ~.~ C~e~t_~fi~cate qf Occupancy_~n P~istin~gg Buildin_qg - $~i00.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.O0 Date ..... <<..~-¢.14f..~ .......................... New Construction ........... Old Or Pre-existing Building..~.. ............ Location of Property..~.Y.¢~... F.~.~.~..4~~.~ .............. ..~...~.~. ~. ~ ................. House No. Street Hamlet Onwer or Owners of Property .... .~..~.~.~.?...~.~.,.f.~.Z??.~.../~., ....... .0..~.. ~.~../~.. .............. County Tax Map No 1000, Section../.~.~ ....... Block .... (~ .......... Lot ...... ~ .............. Subdivision ~ ~q.. ~t . ~. ~//4~-~. ~ ~ ~r~7 .......... Filed ~a~.~M~'' ....... Lot.~.~.~.~./~.Z~.=f..~. .... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...w~.. ..... Fee Submitted: $ ./.~.~P.q... CONSENT TO INSPECTION ~--cc~es- ~, -f L,~r~_~ , CS/-~E/G/ , the undersigned. Owner(s) Name(s) do(es) hereby state: That the unders~ned (is) (are) the owner(s) of the premises in the To~ of Southold located at ~ ~0 ~/q ~ ~ ~e~ ~ ~/~ ~~ . which is shox~ and designated on the Suffolk County tax map as District 1000, Section /~g . Block /~ . Lot ~ That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southold To~ Building Inspector's Office for the follow.g: ~ That {he 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 as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: 11 J'l~/~' ~{ (signature) (print name) (signature) (print name) '-1 I°'oz. z.g .~ol ,6' · ~ ..2! ~ ~, :,, ~,~, I