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Home My WebLink AboutZ-23379 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-23379 Date NOVEMBER 30, 1994 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 4930 OUTH HARBOR ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 3 Lot 3.5 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-23379 dated NOVEMBER 30, 1994 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 RUTH EMERSON WORTIS (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 REPORT. i ing nspector Rev. 1/81 ...- W. - BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT • LOCATION: 4930 SOUTH HARBOR ROAD SOUTHOLD, NEW YORK number & street municipality SUBDIVISION MAP NO. LOT(s) NAME OF OWNER (s) WORTIS OCCUPANCY A-1 RES. type owner-tenant) ADMITTED BY: FRANK ARNOLD ACCOMPANIED BY: SAME KEY AVAILABLE SUFF.CO. TAX MAP NO. 1000-86-3-3.5 SOURCE OF REQUEST: CHARLES CUDDY, ATTY DATE: OCT. 26, 1994 DWELLING: TYPE OF CONSTRUCTION WOOD FRAME STORIES ONE # E%ITS ONE FOUNDATION CEMENT BLOCK POSTS CELLAR CRAWL SPACE TOTAL ROOMS: 1ST FLR. ONE 2ND FLR. 3RD FLR. BATHROOM- (s) ONE TOILET ROOM (s) UTILITY ROOM PORCH TYPE FRONT COVERED DECK, TYPE PATIO BREEZEWAY ' FIREPLACE ONE GARAGE DOMESTIC HOTWATER YES TYPE HEATER ELECTRIC AIRCONDITIONING TYPE HEAT NONE WARM AIR HOTWATER OTHER: ACCESSORY STRUCTURES: NONE GARAGE, TYPE OF CONST. STORAGE, TYPE CONST. SWIMKING POOL GUEST, TYPE CONST. OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION BUILDING CODE LOCATION DESCRIPTION ART. SEC.. REMARKS: INSPECTED BY DATE OF INSPECTION OCTOBER 31, 1994 GAR/1 ISH TIME START 10:30 END 12:30 .. _. .. .. - .. .. .. v.>. __.. .4:r, .�._:�:'_.c+ rrH+.i -, .,r.._.:�.-1 rir+azti3it `►=.''�'?r Form No. 6 TOWN OF SOUTHOLD ' 3 14 BUILDING DEPARTMENT 8 �, TOWN HALL 99 765-1802 s� ELDG.DEPT. _T_OVVN OF SOUTHOLD APPLICATION FOR.CERTIFICATE OF OCCUPANCY 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 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. 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 $25.00, 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date 1994 . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . X. . . . . . . . . . . . Location of Property. . . . .q Q. . . . . . . . . . South_ Harbor. .Road . . . . . . . . . . Southold. . . . . . . . . . . . . . House No. - Street- __ Hamlet Onwer or Owners of Property. . . .Ruth. .Emerson . Wortis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . 086: 00. . . . .Block. . . .Q3 : 00. . . . . . .Lot. 03...M0 j . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . .Cha r1es .R:. .Cuddy. . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .. . . . . . . . Fee Submitted: , $. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-�IIU�: . . . . . . . . . . . . . . . . . �,�s CA37� APPLICANT Charl R. Cuddy D AFFIDAVIT STATE OF NEW YORK) ss. . COUNTY OF SUFFOLK) CHARLES R. CUDDY, being duly sworn, deposes and says: I am the attorney for Ruth Emerson Wortis, who owns certain premises off South Harbor Road, southold, New York, known and described on the Suffolk County Tax Map as District 1000, Section 086. 00, Block 03 . 00, Lot 03 . 002 . The subject premises consists of approximately 1.4 acres and contains a one story residence-cottage which has been used in the summer by the owner. Annexed hereto is a copy of the survey showing the subject parcel, as well as the adjoining parcels. The records for the subject parcel reflect ownership in the present owner's family prior to 1930 and the cottage at the premises was constructed prior to 1957. This information was provided ,to me by the owner, who is an out-of-state resident. I make this affidavit in order to obtain a Certificate of Occupancy on Pre-Existing Building for the building at this parcel (Tax Map No. 1000-086. 00-03 . 00-03.002) . As the attorney for the owner, permission is hereby given for the building inspector to inspect the site and request is made for the issuance of a Pre-Existing Use Certificate. (Charles R. Cuddy Sworn to before me this 027 day of October, 1994 CHARLE R.Cul?0Y Notary Publi State of New York � �� N .`5872225 ! -- Oualifi in'S ffolk County Commission xpires l ecember 31,199#/- UNDA j.COOPER 1 Notary Public,State of NeW York No.4822563,Suffolk County( Term Expires December 31.19:-.-�