HomeMy WebLinkAboutZ-24367 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-24367 Date MAY 20, 1996
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 520 PRIVATE RD. #12 SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 78 Block 6 Lot 6
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-24367 dated MAY 20, 1996
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 SEASONAL DWELLING
The certificate is issued to CHAELS H. & CLAIRE L. WOOLLEY
(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 ATTACHED INSPECTION REP
Building Inspec r
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION• 520 PRIVATE RD. #12 WINDY POINT LANE SOUTHOLD, N.Y.
number & street (municipality)
SUBDIVISION MAP NO. LOT(s)
NAME OF OWNER (s) CHARLES H. WOOLLEY
OCCUPANCY SEASONAL DWELLING
type (owner-tenant)
ADMITTED BY: GLORIA SHIRVELL ACCOMPANIED BY: SAME
KEY AVAILABLE SUFF.CO. TAX MAP NO. ]00 - - -
SOURCE OF REQUEST: WILLIAM H. PRICE, JR. DATE: MAY 2, 1996
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES 1 # EXITS 5
FOUNDATION CEMENT BLOCK & PIER CELLAR NO CRAWL SPACE
TOTAL ROOMS: 1ST FLR. 4 2ND FLR. 3RD FLR.
BATHROOM (s) 2 TOILET ROOM (s) UTILITY ROOM ATTACHED WOOD
PORCH TYPE DECK, TYPE REAR WOOD PATIO
BREEZEWAY FIREPLACE GARAGE
DOMESTIC HOTWATER YES TYPE HEATER ELEC AIRCONDITIONING
TYPE HEAT ELECTRIC-PART OF WARM AIR HOTWATER
OWELLIRG
OTHER: OUTSIDE SHOWER
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. 2 CAR WOOD FRAME STORAGE, TYPE CONST.
SWIMMING POOL GUEST, TYPE CONST.
OTHER:
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VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
a REMARKS: BP #11991-COZ-12107 (ADD) BP #12622Z-CO Z-15682 (GARAGE) BP #14500 CO Z-17386 (ADD)
BP #17144Z-CO Z-175 ( D-PORCH)
INSPECTED BY DATE OF INSPECTION MAY 14, 1996
JO M. BOUFIS TIME START 9:50 END 10:20
TOWN OF SOUTItOLD
BUILDING bEPARTMBNT
MAY 1996
MAY 7.
- 7
�j� TOWN 1lALL `t� �
�996 �� 765-1802
BLDG.DEPT.
3LDG. DEPT. � OWN OF SOUTHOLD _:i� ,
j nls TOWN OF SOUTHOLD u APPLICATION FOR.CCRTIFICATE OF OCCImijG�it'
A. This application must be filled in by typewriter OR ink'and submitted to the building
inspector with ttte followings 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(9-9 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. '
S. Commercial building, ittdus•trial buildingb multiple residences and siauilar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building. '
6: Submit Planning hoard Approval of completed site plan requirements.
B• 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 ,
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
' 1, Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.0.0, 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 '6ver 5 years - $10.00
4. Updated Certificate of Occupancy $50,00
.5. Temporary Certificate of Occupancy - Residential $15.00, Commercial. $15.00
Date i . • :'�l.';'�: : . . . . . • . . . . . : . . . .... . . .
New Construction. . . . . . . . • • . Old Or Pre-existing Building. . . : : : : . • : : i • • • •
Locption of Property. SM. RXT'. 00 .1�' J?M 06- iG fV
House No. . Street hamlet
ORWeC Or Owners of Proper t . • . •A R• •-:•• i�• • • • • i • : • • • • • • • i : • • ii : i • • • + • • • i : . ::.•• • . • •
County Tax Map No 1000, Se.ction• iii0.7.�i . . . .Illack: . .®� • • • • : • • • .Lot: : .�6�. . . . . .:.... . . . .
Subdivision. . . . .,rac. . . . . . + . .. . . . . . . .. .. . . . . . . .Filed tfap. : . . . . , . . . ..Lot. . . .+ . .. . . : . .:.... . . .
Permit Noii Of Permit. . .: :: . . : . . . . : . i4l)licttnti • . . . . + . • : • • : • : • : + : •.••:• • •
Health Dept. Approvals : • • !'f/� . • . . i . . . .. . i • • i : .Underwriters Approval: •.1/.v1: . . • 4 . . . . ..... . . .
Planning Board Approval• • •R1�itt• • i .• i • •• • 4i :• + • i-
Final Certicate: . :
Request for: Temporary Certificate. : . • i • i. : • : A• • . : • .
i
Fee Submitted{ s, • . �.��: . .. ..:i . . 1 . . .::ii .:.
i i: : . : . : • i . : met • . . 6 • •••• • • • .• . • • • . : : • • • ::••• •
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� CONSENT
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TO.
INSPLCTiON
Owners) IV;irne( �� . the undersigned,
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
Of Southold located at 20 .
. %ti-hick is shown and designated on the Suffolk. County tax map as District 1000, Section
Block Lot
That the undersigned (teas) (Have) filed, or caused to be filed, an applic:�-
tion in ,the Southold Town Building Inspector's Office f
r or the followin6`:
� , gi
!
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 wish 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.
Dated;_
(signature)'
(print name)
(signature)
(print name)