HomeMy WebLinkAboutZ-21152FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-21152
Date NOVEMBER 18r 1992
THIS CERTIFIES that the building. ONE FAMILY DWELLING
Location of Property 200 HAYWATERS DRIVE CUTCHOGUE~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 5 Lot 19
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-21152 dated NOVEMBER 18~ 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 DWELLING WITH ACCESSORY WOOD FRAME GARAGE *
The certificate is issued to THOMAS J. & FRANCES M. SMITH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*Pr~ASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
Location
BUILD I,.':G DEPART?~ENT
TO'.',~,! OF SOUTHOLD, N. ¥.
HOUSIZG CODE IHSPECTIOH REPORT
200 HAY~ATRRS DR.
CUTCBOGUE, NE~ YORK
~numoec ~ asreec)
Subdivision ~Iap No.
N~me of Owner(s) THOMAS J. & FRANCES M. SMIT~
Occupancy A-I RES. OWl/ER
Ad~,~itted by:
Key ~vailable
(~:ype)
FRANCES SMITH
Accompanied by:
Suffolk Co.
T~OMAS J. & F~A~tiS-S~TTa
Source of request
Tax Ito. 104-05-19
NOV- 16, 1992
Date
D~'~LLI~:
Type of construction
Foundation
Total rooms,
Bathroom(s)
Porch, ~=~e
Breezewaz
Type Heat OIL
Fireplace(s) NO
Domestic hotwater
Other
WOOD FRAHE
CI/t4ENT BLOCK
1st. Fi
Deck, t:ype,
Garagq
· Warm Air
No. v.:cits 2
YES
#stories ONE
Cellar I/2 Crawl space
2nd. FI 3rd. FI
Toilet room(s)
Patio, type
Utility room
.Hotwater xx
Airconditioning
Type heater OIL
ACCESSORY STRUCTD?~ES:
Garage, type const. WOOD FRAME
Swim. ming pool
Other
Storage, type coast.
Guest, type coast.
VIOLATIONS:
Lncation [
.CHAPTER 45--N.Y. STATE UNIFORM FIRE PILEVENTION & BUILDING CODE
Description I Art. I Sec.
Remarks:
Date of Insp.
Time start 9:30
NOVEMBER 17, 1992
end 9:45
Z~'..,,,, Form No. 6
': APPLICATION FOR, CERTIFICATE OF OCCUPANCY
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 f(om Board of Fire Underwriters.
Sworn statement from plumber certifying that the solder ~sed in system contains
less than 2/10 of 1% lead.
$. Commercial building, industrial b~ilding, multiple residences an~ 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.
~> (prior ~p non-conforming uses, or buildings
For
existing
buildings
and
.'-~re-_~x__isting" land uses:
1. -Accurate surve~z of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed _a~Eplicatio_~n_an~'~ 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
~. 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 $50.00.
~.~ Certificate of Occupancy on fre-~~Zui~in_g~.$~j_10P~,_0J3
3. Copy of Certificate,of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ........ . ....................... · ........
Construction..' ......... Old Or Pre-existing Building ...............
' . . House ~o. ~ Street ~ /'Hamlet
,d£vt~ton ..................... ;; .... ; ........ Filed Map ............ Lot ......................
mit No Dat~ Of Permit Applicant
lth Dept. Approval .......................... Underwriters Approval .........................
nnlng Board Approval · ' '
ms~ for: Temporary Certificate ........ F~nal Ce~rt~ate ..... /../~.. ' - ·
Sub , . /oo. ~ ' · ' . '2
mittea: ~ ..... : ........ ........... · . , · · -
........... ~.~ . ,~ .~ ......... ./.,~ ........... - .... · .
SIS(' - . ' . (_ PUC T ........ ',--
do(es) hereby state:
CO ~NS E,';T
TO
/
That the undersigned (15) (a~c) thc ovmcr(s) of thc prcmiac:; £n ibc To~:m
of So'4thold located at
· which is shown and dcsi~.n.n/cd on the Suffolk
County tax map as District 1000, Section/?~_i~, ~loct¢ ~v~'- .. Lot /~
That tile undersigned (hms} (have) (ilcd. or caused to be filed· an applica-
tion in the Southcld Totrn Euildin.~ Inspector's Office for thc followLn, f:,__
/_ , : : / f --
That the undersigned do(es) hereby give consent to the Buildlnf Inspectors
of ~he Town of Southold to enfer upon the above described property, including
an.'.' and all buildings locgted thereon, to conduct such inspections ~$ they may
deem necessary with respect to thc aforesaid applica:ion, inc!u~Ln% inspcc~ic.-.s
1o determine that said premises comply with all of the laws; ordinances, .rules
and re.~ulations of the Town cf Southold.
The undersigned, in consen/in,~ to such inspections, do(es) so ~¢ith the
kno:vledgc and understanding that any information obtained in the conduc~ of
such inspections may be used as evidence in subsequent prosecutions for
Iation$ of thc laws, ordinances, rules or regulations of d~e Towq/~fSou/hold.
"
Dated' //
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