HomeMy WebLinkAboutZ-23173FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-23173
Date AUGUST 23, 1994
THIS CERTIFIES that the building. OWE FAMILY DWELLING
Location of Property 4930 STILLWATER AVE. ~WJTCHOGUE; N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 137 Block 2 Lot 11
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 CERTIFICATE OF
OCCUPANCY NUMBER Z-23173 dated AUGUST 23, 1994
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 OWE FAMILY DWELLING WITH ACCESSORY STORAGE SHED *
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*P!.~%SE SEE ATTACHED INSPECTION~RT.
Rev. 1/81
ANNUNCIATA PAOLUCCI & ANO
N/A
N/A
N/A
LOCATION:
BUILDING DEPARTHENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
4930 STILLWATER AVE. CUTCHOGIJE, N.Y.
(number & street) (municipality)
SUBDIVISION
NAME OF OWNER (s)
MAP NO. LOT(s)
ANNUCIATA PAOLDCCI
OCCUPANCY SINGLE FAMILY DWELLING
(type)
ADMIT'rED BY: JOYCE VORCE
EY AVAII~LE
SOURCE OF REQUEST: ADAM R. PAULEY,
(owner-tenant)
ACCOMPANIE~ BY: SAME
SUFF.CO. TAX MAP NO. ]000-131-2-11
DATE: JULY 16, 1994
DWELLING:
TYPE OF CONSTRUCTION
FOUNDATION
TOTAL ROOMS: ]ST FLR.
BATHROOM (s) l
PORCH TYPE
BREEZEWAY
DOMESTIC HOTWATER
TYPE HEAT OIL
OT~R:
WOOD FRAME
CEMENT BLOCK
CELLAR
4 2ND FLR.
TOILET ROOM (s)
FIREPLACE
YES TYPE HEATER
WARM AIR
{ STORIES
FULL CRAWL SPACE
3RD FLR.
UTILITY ROOM
BECK, TYPE PATIO
GARAGE
AIRCONDITIONING
HOTWATER
ELgCTRIC
YES
I { EXITS
CARPORT, TOILET ROOM & UTILITY ROOM ATTACHED ON Ex'r~RIOR
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.
SWIMMING POOL
OTHER:
STORAGE, TYPE CONST. S~kLL WOOD SMED
· GUEST, TYPE CONST.
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
- JOHI~M. BOUFIS ~ '
INSPECTED BY
DATE OF INSPECTION JULY 29, 1994
TIME START 9:30 END mo=00
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT !'
TOWN HALL
765-1802
BLDG DEPI
APPLICATION FOR CERTIFICATE OF OCCUPANCY T~W~ OFSOUTHOLD
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:
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 simi~'r 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 w~iting 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 Building - $100.00
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 $15.00
Date 7/21/94
New Construction ........... Old Or Pre-existing Building..~..~0~.Shed ....
Location of Property.. 4930 Stillwater Avenue, Cutchogue, NY
House No. Street Hamlet
Onwer or Owners of Property. Estat~ of t0uis Paolucci
County Tax Map No 1000, Section. 137 .Block. ~ .Lot..TM
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval .......................... Underwriters App~ ........................
Planning Board Approval ........................ // ,..//
Request for: Temporary Certificate ........... Final Certic/~.t.t. ~..,// .....
· 100 GARY FLANNER OLSEN, ESQ. ,.. '" .
Fee Submitted. $ ................ .... P.'0.'~0~ ~0~ /Z,~~~'~ ~
CUTCHOGOE, ..y. ..........................
Co-Z o13 / _
CONSENT
TO
INSPECTION
iAdam R. Pauley as Administr'ator ~f the Estate of
'~ Owner(s) .Name(s) Louis Paolucci
do(es) hereby state:
..o the ~undersigned,
That the undersigned (is) (nre') the owner(s) et the premises in the TOwn
of Southold located at 4930 StillQater Avenue, Cutchogue, New York
.... , which is shown and designated on the Suffolk
County tax map as District 1000, Section 137 , Block 2 , Lot 11.. . .
% .
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in"%~m-Southold Town BuUalng Inspects, .o ott~oo to,, ~, Cnllowin~:
One family dwelling with shed
That the undersi~ned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, incl.uding
....... 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 tnspe.ctions, do(eS) so with the
knowledge and understanding that any' information obtained In the conduct
such inspections may be used as evidence in subsequent prosecutions for vie-
lations of the laws, ordinances, rules or regulations of the Town of Southold.
· . (signature)
Adam R. Pauley
(print name)
(signature)
· DLDG D~T"r
' (print name) ~"
::.I: "
BLDG. DEPT
TOWN OF