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Home My WebLink AboutZ-26046FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 26046 Date: 10/20/98 THIS CERTIFIES that the building DWELLING Location of Property 520 LAUREL AVE SOUTHOLD (HOUSE NO.) (STREET} County Tax Map No. 473889 Section 056 Block 0003 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- 26046 dated OCTOBER 20, 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 & STORAGE SHED * (m~LET) Lot 001.002 The certificate is issued to DOROTHY POLIWODA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A N/A N/A ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Building Inspector/ Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 520 LAUREL AVE SUBDIVISION: NAME OF OWNER (S): DOROTHY POLIWODA OCCUPANCY: SINGLE FAMILY ADMITTED BY: DOROTEY DOLIWODA SOUTHOLD MAP NO.: __LOT (S) -- DOROTHY POLIWODA ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: SOURCE OF REQUEST: DOROTHY POLIWODA -10/07/1998 DATE: 10/20/98 TYPE OF CONSTRUCTION: FOUNDATION: CEMENT BLOCK TOTAL ROOMS: 1ST FLR.: __~ BATHROOM(S): 1.0 PORCH TYPE: FRONT ENCLOSED BKEEZEWAY: DOMESTIC HOTWATER: XX TYPE HEAT: OIL WARM AIR: WOOD FRAME 2ND FLR.: _~ TOILET ROOM(S): DECK TYPE: FIREPLACE: TYPE HEATER: LIPA HOTWATER: OTHER: BILCO EXIT. PANTRY. REAR MUD ROOM STORIES: 1.5 # EXITS: ~ CELLAr: FULL CEAW-L SPACE: 3RD FLR.: ~ UTILITY ROOM(S): __ PATIO TYPE: ROOF OVER CONCP-ETE GARAGE: AIRCONDITIONING: XX ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: 1 CAR WOOD WITH STORAGE STORAGE, TYPE CONST.: WOOD SHED {BAD SHAPE) SWI~4ING POOL: GUEST, TYPE CONST.: OTHER: BARBECUE PIT VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE pREVENTION & BUILDING CODE LOCATION DESCRIPTION ST- INSPECTED BY: /N~M. BOUFIS TIME START: 10:10 END: 10:35 OCT 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 buildin~ 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 Underwritersl 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 buildin 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, ol'buildings an '!pre-existing" land uses: 1. Accurate survey of property showing ali 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. 2. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certificate of Occupancy - = -25¢. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . .~. ~4~. ~ r.~/. ~ ~ ................. New Construction ........... Old Or Pre-existing Building ..... ~ .......... Location of Property... ~. .......... .L~. ~eJ...~gg~.~ ........ So.~.~h~.~ ............. House No. Street H~mlet Onwer or Owners of Property......~~ ...... ............. . .................... County Tax Map No I000, Section....~.~ ....... Block .... .~ .......... Lot...):~..~.~'~q ....... Subdivision .................................... Filed Map ............ Lot ........... :~ ........ Permit No ................ Date Of Permit ................ Applicant ................... '.~ ....... Health Dept. Approval .......................... Underwriters Approval ....................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~. ..... Fee Submitted: $ ......... ; .................... ...... CONSENT TO INSPECTION Own'er(s) do(es) hereby state: Name(s) · the undersigned. That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at 5~t0 L-I~u~C/ ~V~.~Vv~6'; SO~t~',ol~ · which is shown and designated on the Suffo~ County tax map as District 1000, Section ~-~ , Block ~ , Lot ~:~ ~ That the undersigned (has) (have) filed, 'or caused to be filed· au applica- tion in the Southold To~ Building Inspector's Office for the follow~g:.~ 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 [n the conduct of such inspections may be used as evidence in subsequent prosecutions for lations of the laws, ordinances, rules or regulations of the Town of Southold. - , (signature) (prilSt name) 97.;32' / - - $. 19.34':30' E. ~ N. 9'51'20" 168.00' L A UREL A VENUE