HomeMy WebLinkAboutZ-20958FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-20958
Date AUGUST 20~ 1992
THIS CERTIFIES that the building
Location of Property 4325 DEPOT LANE
House No.
County Tax Map No. 1000 Section 96
Subdivision
ONE FAMILY DW~.LLING
CUTCHOGUE r N.Y.
Street Hamlet
Block 5
Filed Map No.
Lot 6
Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9r 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-20958 dated AUGUST 20~ 1992
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 DW~.LLING WITH ACCESSORY FRAME GARAGE *
The certificate is issued to EVA SMITH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTHAPPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLRASE SEE ATTACHED INSPECTION REPORT.
N/A
Bui~g I{/spec~or
Rev. 1/81
Location
BUiLDi[;C
TO':g! OF SCUT[iOLD, N. Y.
HOUSI::G CODE IUSPECTI0?~ REF02T
4325 DEPOT ~ C~CH~, N.Y.
Subdivision
Nmme of Owner(s) EVA SMITH
0ccupan~y ! FAMILY
Nap No.
(VACANT)
A~mitted by:
(~ype)
BUD CYBULSKI
(ot.;~er- certain)
SAME
Accompanied by:
Key available
Suffolk Co. Ts~z ~I°. 96-5-6
Source of request
GARY OLSEN, A'rfY
Date
8/14/92
DI'~LLI~:
,Type of construction
Foundation MASON BLOCK
Total rooms, 1st. Fi
Bathroom(s) 2
Porch, type ! CLOSED IN
Breezewa~
Type Heat OIL
Fireplace(s)
Domestic hotwater
Other
5
Deck, typq
Garage
'Warm Air
No. ~cits
#stories 2(pazt)
Crawl space 20~
5rd. F1
Cellar 80Z
2nd. F1 ~
Toilet room(s)
Patio, typeFLAGSTONE
Utility room
Hotwater STEm~
Airconditicning .
Type heater OFF FUBNACE
~ ....... ST..UC ~ UR_S:
Garage, type const. FRAME
Swim. ning pool
Other
Storage, type const.
Guest, type const.
VIOLATIONS:
Lncation
.CIIAPTER 45--N.Y. STATE UNIFOI~! FIRE PREVENTION & BUILDING CODE
Description I ~r } Sec.
Remarks
Date of Insp. AUGUST 18, 1992
· Time start 9:35 end 9:50
FORM NO, §
TOWN OF SOUTHOLD
· Buildimj Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FO~ C~TIFICATE OF
Instructions
This application must be filled in typewriter OR ink, and submitted ,= _- ..... to the Building Inspec-
tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-{S-9 form or equalJ.
3. Approval of electrical installation from Board of F ire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
-For existing buildings {prior to April 1957}, Non-conforming usus, or buildings and "pre-existing"
land uses:
1. Accurate sun~ey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa*
Lion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $25;00-- BUSINESS $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50. O0
3. Copy of certificate of occupancy $ 5.'00. over 5 yeats $I0.00
4.Vacant Land C.O. $'20.00 August 12. 1992
5.Updated C.O. $"$0.00 Date ..........................
NewC°nst,r'ucr-ion ...... Old or Pre-exi~ting Buildin[j ...X. ........ .V~acant Land .......
Location of ProperW ....4.32..5..D.ep..o~..L.a.n.e. ...... ~qt, ql~qgq~ ...........................
Hou~ No. Street Hamlur
Owner or Owners of Property Eva Smith ..,
County Tax Map No. 1000 Section . .9.6. ........... Block ...5. ........... LOt....(5 ............
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................' '~'~''/ ~/
Request for Temporary Certificate ................. .~..I-mai L;ert~l~cate ...............
Fee Submitted $,. ~.0.0. :0.0... ....................
Cary Flannor Olsen. [sq.
Rev. 10.10.79
¢1
CONSENT
TO
INSPECTION
--'~-;//~ ~-~,~', 7-/4 , . the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises fin the Town
of Southo d located at
~¢- ~ ., which is sho~ and designated on the Suffo~
Coun~y tax map as nistric~ 1000, Section ~ , Block ~--, Lot ~ .
Tha~ ~he undersigned (has) (have) filed, 'o~ caused to be filed, an applica-
tion in~h- Southold To~
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, fincludfing 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 he 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)
(siEnatdre)
(print name)
"8