HomeMy WebLinkAboutZ-19296FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-19296 Date AUGUST 15e 1990
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 4600 NEW Sb~'OLK ROAD
House No. Street
County Tax Map No. 1000 Section 110 Block 8 26
Subdivision Filed Map No.
conforms substantially to the requirements for a private one family
dwelling built prior to: APRIL 9e 1957 pursuant to which
NEW SUFFOLKe N.Y.
Hamlet
Lot
Lot No.
CERTIFICATE OF OCC. #Z-19296 dated AUGUST 15{ 1990
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 DWF. LLING WITH ACCESSORY (ONE) CAR GARAGE *
The certificate is issued to
of the aforesaid building.
BERTHA A. ST.RnJESKIr DECEASED
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NO RECORD PRE EXISTING
UNDERWRITERS CERTIFICATE NO. NO RECORD PRE EXISTING
PLUMBERS CERTIFICATION DATED NO RECORD PRE EXISTING
*PLRASE SEE ATTACHED INSPECTION REPORT.
~~'a~Bu~d~n~inspector
Rev. 1/81
Location
BUILDI?:G DEP}d{TF~NT
T0%'~; OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
4600 NEW SUFFOLK ROAD
~numoer ~ street)
Subdivision
Nmme of Owner(s)
Map No.
NEW SUFFOLK, N.Y.
(i'iunlclpaiisy)
Lot(s)
BERTHA A. SLEDJESKI, DECEASED
Occupancy. R-40
A~mitted by: THOMAS SLEDJESKI
Key ~vailable
Source of request
(owner-Eenanv)
Accompanied by: SAME
Suffolk Co. Tax No. 1000-110-8-26
THOMAS SLEDJESKI
Date 8/13/90
D%'~LLING:
Type of construction
Foundation CEMENT BLOCK
Total rooms, 1st. F1 5
Bathroom(s) ONE FULL
Porch, type
Breezewa~
Type Heat LILCO
Fireplace(s)
Domestic hotwater
Other
WOOD FRAME
Cellar 3/4
2nd. F1 --
Toilet room(s)
Deck, type
Garag~
· ~ar-m Air xx
No. ~its 2
LILCO ~ype heater
#stories ONE
Crawl space 1/4
3rd. F1 --
Patio, type
Utility room
.Hotwater
Airconditioning
RHEEM
ACCESSORY STRUCTURES:
Garage, type const, i CaR wood
Swimming pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS:
Descriotion
.C~APTER 45--N.Y. STATE UNIFORM FlEE PREVENTION & BUILDING CODE
Location
Remarks: BP #5753-Z - CO Z-5221 FOR AN ADDITION.
Inspected by: ~mz~i- ~m~ Date of Insp.
~ar~/~/.-~w ~ish · Time start 9:35
8/15/9o
end 9:$0
TOWN OF SOUTHOLD
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 l{nes,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept.' of water supply and sewerage-disposal(S-9 ferm).
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
.o,
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.
Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00
4. UpdaLcd Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date f~. ~7/f~ ........
Construction .... ~ ...... Old Or Pre-existing Building ..... ~ ......
. cat,on of P=operty .... ............
House No. Street
county Tax 1000, Section... ..d.O. .... ........ ...............
SubdiVision ' Filed Map Lot "..
Permit No ................ Date Of Permit. ............... Applicant ........................... ..
Ilealth Dept Approval Underwriters Approval . ......~.'
Planning Board Approval ........................
Request'for: Temporary Certificate ....... Final Certicate .... .~. .... ..
Fee Submitted. ~ .. ..
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) ~the owner(s) of the premises tn the Town
of Southold located o o
/
.~j,~/~-v/~/Y~ , which is shown and designated on the Suffolk
County tax map as District 1000, Section ~/d) · Block ~ ~ , Lot ~
That the undersigned (has)~-~I filed, or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the followtng: __
That the undersigr~"~ do(e_~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 Southotd.
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: ~//~/~, ~)
(signature) /
(print name)
(siffnature)
(print name)
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