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Home My WebLink AboutZ-25906FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 25906 THIS CERTIFIES that the building DWELLING Location of Property 3645 MILL RD (HOUSE NO.) County Tax Map No. 473889 Section 067 Subdivision Filed Map No (STREET) Block 0002 Lot No. Date: 08/21/98 PECONIC (HAMLET) Lot 011 conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 25906 dated AUGUST 21, 1998 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 ACCESSORY GARAGE.* The certificate is issued to CHARLES G PETERSON & WF. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. Buil g Inspec or Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 3645 MILL RD PECONIC SUBDIVISION: MAP NO.: LOT (S) NAME OF OWNER (S): CHARLES G PETERSON & WF. OCCUPANCY: SINGLE FAMILY CHARLES G PETERSON & WF. ADMITTED BY: SHEILA RICCA ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 67.-2-11 SOURCE OF REQUEST: CHARLES W. PETERSON DATE: 08/21/98 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1..,5 # EXITS: 2 FOUNDATION: BLOCK CELLAR: CRAWL SPACE: YES TOTAL ROOMS: IST FLR.: 1 2ND FLR.: 1 3RD FLR.: 0 BATHROOM(S): 1.0 TOILET ROOM(S): 1.0 UTILITY ROOM(S): PORCH TYPE: ENCLOSED COVERED -BACK DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: YES GARAGE: DOMESTIC HOTWATER: YES TYPE HEATER: GAS -LP AIRCONDITIONING: TYPE HEAT: ELECTRIC WARM AIR: HOTWATER: OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: WOOD FRAME* SWIMMING POOL: GUEST, TYPE CONST.: OTHER: TOOL SHED W/OUTDOOR SHOWER BUILT AFTER 1967 VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE _LOCATION ! DESCRIPTION ART. SEC i i INSPECTED BY: " DATE ON INSPECTION: 07/23/98 TIME START: 10:25 END: 11:05 MAP OF' SURVEVEr? 4 A L W P T,6wr-,i Noic-j-c,f ovvrrye-Vey-** PM43P of V�Wcor.*.Q Sl,cwo f;jecA %,H 0 of the Now Yn* $ft" LZA 1 11 Survoyoes Vdmd sot or w,`mcvd seal shall not ba r slder*A 1.* to a MM Um W* r.,a ,tioes bxkded hereon shag -A to Vic p~ for Whom thS 5{ ,Vy L and m his boholf!O tt4 J :3L,.-Lcv Ww sc 01 N, 54 30_E_. ILI LA Lt ^ fill Z IHQAq1 oh IiHC 25� [_ _. Q_. o~r I�fta -7 -._ O7� � �i S. 34' 30'W (4:2.10 C) Sk NA L44'+ 4L.; -Pi le N= 654 MAP OF' SURVEVEr? 4 A L W P T,6wr-,i Noic-j-c,f ovvrrye-Vey-** PM43P of V�Wcor.*.Q Sl,cwo f;jecA %,H Sc CA I,- - 3O eG r, Fj k w 4r, GLAC( Y cJ H t e Oe -+if t, CNtAcl c(f, d Ti 4 1 c Div C:Q. as SuN veLgec( YA N -rU 'y � sq Su va Ljc'fw New yovk of the Now Yn* $ft" LZA o!!!ljs surmy ma? not toaxim Survoyoes Vdmd sot or w,`mcvd seal shall not ba r slder*A 1.* to a MM Um W* r.,a ,tioes bxkded hereon shag -A to Vic p~ for Whom thS 5{ ,Vy L and m his boholf!O tt4 J :3L,.-Lcv Ww sc 01 ILI Sc CA I,- - 3O eG r, Fj k w 4r, GLAC( Y cJ H t e Oe -+if t, CNtAcl c(f, d Ti 4 1 c Div C:Q. as SuN veLgec( YA N -rU 'y � sq Su va Ljc'fw New yovk Norm No. b TOWN OF SOUTHOLD BUILDING DEPARTKENT 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. 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 - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date...�... �! 8 ........................... few Construction........... Old Or Pre-exist g Building.. .... .. .ocation of Property .... ..36.... .. (. .. . OA D .................�ECp�/ .. ............ . House No. Street r Hamlet Mwer or Owners of Property....... CCS.. .... ........SOe✓.. '..(1i ......................... .ounty Tax Map No 1000, Section... . V ....... Block .... Z .........Lot...! ................. ;ubdivision....................................Filed Map ............ Lot ...................... 'ermit No................Date Of Permit ................ Applicant ............................. iealth Dept. Approval..........................Underwriters Approval......................... Manning Board Approval........... .......... tequest for: Temporary Certificate........... Final C Fee Submitted: $............................. Pa. Cm O -Y -lnO f- 2 ccica - ...... CANT.................. CONSENT TO INSPECTION s) Name(s) do(es) hereby state: the undersigned, That the undersigned (is) (are) the owner(s) of ffftthe premises in the Town of Southold located at 36�� IIID F C AO ✓ ��'Od// C - which is shown and designated on the Suffolk County tax map as District 1000, Section 67 Block z Lot That the undersigned (has) (have) filed, 'or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: ch , �t}To ftALD p/ -11,6 o �/�e'r96E (sac- DAiE f'omfLY 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 as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of tAO/Town Dated: %- /3 " 96 LGr� 0z CSh�I��icc C �l � (sWatur/e) / (print name) (signature) (print name) BUILDING DEPARTMENT TOWN OF SOUTHOLD �- MOUSING CODE INNSSPECTTIIIOON REPORT LOCATION: number & street municipality SUBDIVISION MAP NO. LOT (s) NAME OF OWNER (s) OCCUPANCY Id/1" J� Ile, ADMITTED BY: G�lY R v ACCOMPANIED BY: .iCLC� KEY AVAILABLF,_ SUFF. CO. TAX MAP NO. /ODQ - 1Q 7 SOURCE OF REQUEST: DATE: -:7Z� DWELLING: TYPE OF CONSTRUCTION Lw "�"� # STORIES ��z„ # EXITS - FOUNDATION CELLAR CRAW. SPACE TOTAL ROOMS: IST FI.R. 2ND FLR. 2(•)3RD FLR. BATHROOM (s) TOILET ROOM (s) �X�'Gv' UTILITY ROOM PORCH TYPE" e4i c DECK, TYPE PATIO, TYPE �----t BREEZEWAY FIREPLACE l�,Q�_ GARAGE DOMESTIC HOTWATER TYPE HEATER ' L, P AIRCONDITIONING TYPE HEAT ARM AIR HOTWATER OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST. SWIMMING POOL OTHER: STORAGE, TYPE CONST. GUEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE DING CODE 1 I REMARKS: INSPECTED BY: DATE ON INSPECTION 3 �8 TIME START �_`�.S END `• O `— DESCRIPTION W.R... / I MM _w_ P� REMARKS: INSPECTED BY: DATE ON INSPECTION 3 �8 TIME START �_`�.S END `• O `—