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Home My WebLink AboutZ-22258FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22258 Date APRIL 14~ 1993 THIS CERTIFIES that the building. Location of Property 2755 WESTPHALIA ROAD House No. Street County Tax Map No. 1000 Section 114 Block 10 Subdivision Filed Map No. ONE FAMILY DWELLING MATTITUCK, N.Y. Hamlet Lot 20 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-22258 dated APRIL 14, 1993 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 * The certificate is issued to GLORIA A. STACHACZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PleASE SEE ATTACH~.D INSPECTION REPORT. ' ~ / ~ildin~ Inspector Rev. 1/81 BUILDING DEPARtmENT TOI~IOF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 2755 WESTPHALIA ROAB MATYITUCK, NEW YORK (number & street) (municipality suBDIvISION -MAP NO. LOT (s) NAHE OF OiliER (s) GLORIA A. STACHACZ ( EDHUND STACHACZ). OCCUPANCY I FAHILY DWELLING Ob~NER . (type) ADMITTED BY:. E. ZENESKI KEY AVAILABLE sOuRcE OF REQUEST: GLORIA STACHACZ (owner-tenant) ACCOHPANIED BY: SAHE STIFF. CO. TAX HAP NO. 1000-114-10-20 DATE: APRIL 12, 1993 DWELLING: TYPE OF CONSTRUCTION FOUNDATION Cf/RENT BLOCK TOTAL ROOHS: IST FLR. BATRROOH (s) I PORCU TYPE BREEZEWAY DOHESTIC HOTWATER ~x TYPE HEAT OIL OTIfliR: FRAME ~ STORIES I # EXITS CELLAR XX CRAWL SPACE 5 2ND FLR. 3RD FLR. TOILET ROOM (s) UTILITY ROOM DECK, TYPE PATIO· TYPE FIREPLACE GARAGE TYPE UEATgR COIL FROM OIL AIRCONDITIONING WARH AIR HOTWATER X'X ACcEsSORY STRUCTURES: GARAGE, TYPE OF CONST. SWIItilNG POOL OT~R: REC ROOM IN CELLAR STORAGE, TYPE CONST. · GUEST, TYPE CONST. ACCESSORY GARAGE BOII2)ING PERKIT {12457Z-CO Z-11955 VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVEIFrlON & BUILDING CODE LOCATION DESCRIPTION ART. SEC. INSPECTED BY: TH0i{AS J. FISHER DATE ON INSPECTION APRIL 13~ 1993 TIME START 3:30 PM END 4:00 PM 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 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, buildimg 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 i. 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building~..~. House No. Street Hamlet 0nwer or Owners of Property ..... ~ .......................... County Tax Map No ·i000, Section .... ~.~.. .... Block · ./.~. ..... Lot ....... ~.' ........... 3ubdivision ............................... Filed ~ap ............ Lot ...................... 'ermit No .... ~.-.**.. ...... Date Of Permit ........... ..Applicant ......................... ~ealth Dept. Approval .................. Underwriters Approval .................. ~lanning Board Approval ..... ; ............. · quest for: Temporary Certificate ........... Final Certicate ........ 'ee Submitted: $.Z~..~. ................... CONSENT TO INSPECTION Owner(s) Name(s) do(es) hereby state: · the undersigned, That the undersigned (is) (are) the owner(s) of the premises in the Town of Southoldlocated at c~,7~5 L4Je_~-lohqt[ a_ It4 ~ o~-~T~Tot-i~ ! )~J, V , which is shown and designated on the Suffolk / County tax map as District 1000, Section ~/2-/ · Block /~ , Lot c~Z~ 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:__ ~c.~ CO 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 ail buildings located thereon, to conduct such inspections as they may deem necessary ~vith respect to the aferesaid application, including inspections to determine that said premises comply xvith ali 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 the Town of Southold. (signature) (print name) (signature) (print name) 01 O'~,c)z 0