HomeMy WebLinkAboutZ-18028 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18028 Date MAY 15, 1989
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 375 PRIVATE ROAD #19 SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 5-4 Block 01 Lot 10
Subdivision Filed Map No. Lot No.
conforms substantially to the requirements for a private one-family
dwelling built prior to: APRIL 23, 1957 pursuant to which
CERTIFICATE OF OCC. Z-18028 dated MAY 15, 1989
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 JOHN F. WITHERSPOON
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NO RECORD PRE-EXISTING
UNDERWRITERS CERTIFICATE NO. NO RECORD PRE-EXISTING
PLUMBERS CERTIFICATION DATED NO RECORD PRE-EXISTING
*PLEASE SEE ATTACHED INSPECTION REPORT
c
Buil ng Inspector
Rev. 1/81
BUILDINIG DEP RT iE;iT
TO N OF SOUTHOLD, N. Y.
HOUSII-M CODE INSPECTION REPORT
Location 375 Private Road # 19 Southold , N .Y .
( ummoer do s zreez) (i-iunicipaiity)
Subdivision Map No. Lot(s)
,Name of O;vner(s) JOHN WITHERSPOON
Occupancy ONE FAMILY DWELLING OWNER
zyp e own er-z enanz)
tni(i:li4- ed by: OWNER -AGS�Ump�:..riied b OWNER
y
Key available I ' Suffolk Co. Tax No. 54- 1- 10
Source of request OWNER Date 3/8/ 1989
DWELLING:
Type of construction FRAME rstories 2
Foundation masonery(cement block) Cellar Part Crawl space
Total rooms , lst. Fl BASEMENT 2nd. Fl 5 3rd. Fl --
Bathroom(s) 1 Toilet room(s) --
Porch, type ---- Deck, type over cellar patio, type
Breezeway -- Garage 5 Utility room
Type Heat OIL Warm Air — Hotwater Steam
Fireplace(s) 1 No. Exits .2 Airconditionir_g
Domestic hotwater yes Type heater OIL
Other partial basement
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Slvimmli ng pool Guest t
yp e const.
Other
VIOLATIONS: CHAPTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
Location Descriation Art.
� I
I
I
Remarks: Building Permit # 17965-Z for addition under construction
Inspected by• Daie of Insp. 4/14/89
Tho s J Fisher ; Time start 3: 13 pm end 4:00 pm
lit
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
DATE.
NEW CONSTRUCTION . . . . - - -OLD OR PRE-EXISTING BUILDING. _ . . VACANT LAND. . . _ . . . :
Location of Property. . . . . . . . . . . . . . . . . . . . 'u'' Sr; /�
HOUSE NO. STREET HAMLET
Owner or Owners of Property. .G6.n. .� ... 14).t ( l�JP. . h_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
County Tax Map No. 1000 Section .J. . . Block . 1. . . . . Lot . !. . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . Filed Map . . . . . . . .Lot . . . . . . . . . .
Permit No. . . . . . . . . . .Date of Permit . . . . . . . . . .Applicant . . . . . . . . . . . . . . . . . . .
Health Dept . Approval Underwriters Approval . . . . . . . . . . . . . .
Planning Board Approval . . . . . . . . . . . . . . . .
Request for Temporary Certificate
. Final Certificate . . . . . . . . . . . . . . . .
Fee Submitted :
APPLICANT . .`,:�. . . . . . . . '.0 . . . . . . . . . . . .
rev- 10/ 14/88
CONSENT
TO
INSPECTION
the undersigned,
Owner(s) Name(b)
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at �giknni2o/ m�
which is shown and designated on the Suffolk
County tax map as District 1000, Section ,��/ Block �, Lot
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:
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 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.
D ate d: �...,,
\ (signature) (11
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(print name)
(signature)
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