HomeMy WebLinkAboutZ-23547 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-23547 Date MARCH 14, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 35260 MAIN ROAD CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax -Map No. 1000 Section 97 Block 2 Lot 4
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-23547 dated MARCH 14, 1995
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 GARAGE *
The certificate is issued to ANTONE J. & ROSEMARY T. WYSOCKI
(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 REPO
Building Inspec or
Rev. - l/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 35260 MAIN ROAD CUTCHOGUE,. N..Y.
number & street municipality
SUBDIVISION MAP NO. LOT(s)
NAME OF OWNER (s) ANTONE J. & ROSEMARY T. WYSOCKI
OCCUPANCY SINGLE FAMILY OWNER
type owner—tenant)
ADMITTED BY: ANTONE J. WYSOCKI, JR. ACCOMPANIED BY: SAME
KEY AVAILABLE SUFF.CO. TAX MAP NO. 100 — — —
SOURCE OF REQUEST: ANTONE & ROSEMARY WYSOCKI DATE: MARCH 2, ..1995
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES 2 it EXITS 2
FOUNDATION BRICK CELLAR FULL CRAWL SPACE
TOTAL ROOMS: 1ST FLR. 4 2ND FLR. 2 . 3RD FLR.
BATHROOM (s) ONE TOILET ROOM (s) UTILITY ROOM
PORCH TYPE REAR ENCLOSED BECK, TYPE PATIO
BREEZEWAY FIREPLACE GARAGE
DOMESTIC HOTWATER YES TYPE HEATER OIL AIRCONDITIONING
TYPE HEAT OIL WARM AIR HOTWATER YES
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. 1 CAR WOOD FRAME STORAGE, TYPE CONST.
SWIMMING POOL GUEST, 'TYPE CONST.
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE M
LOCATION DESCRIPTION ART_ SEC.
1
REMARKS:
17
INS?ECTED BY DATE .OF INSPECTION MARCH 7, 1995
JOHN M. BOUFIS
TIME START 9:45 END 10: 10
y
Form No. 6
TOWN OF SQ
UTHOLD
_
BUILDING DEPARTMENT
TOWN HALL MAR - 3 1995
765-1802
TOV"N OF
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 - $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
Date March. 2,. 1995. • . . . • . . . . . . . . . . . . . . . . . .
1
New Construction. . . . . . . . . . . Old Or Pre-existing Building. X. . 4�2, story, frame house and detached
garage
Main Road, Cutcrogue. . . . . . . . . . . . . . . . . . . . . .
Location of Property. . . . . . • ' • " . . . . . . . . . .Street Haml p
House No.
Antone J. Wysocki Jr. and Rosemary. T,. Wy�ppk;. . . . . . . . . . . . . . . . . . . .
Onwer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . .
097.00 .B1ock. 02:00 . . .Lot. . . . 004;000. . . . . . . . . . .
County Tax Map No 1000, Section. . . . . . . . . . . . . • • • • ,
Subdivision. . . . . . . . . . . . . . .. . . . . . . . . ... . . . . . . . . .
. . Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
Permit No. . . . . . . . . . . . . . . .Date Of. Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . .. . . . . . . . . . . . .Underwriters Appr . . . . . . . . . . . . . . . . . . . . . . •
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Cert'c te. . . . . .
Fee Submitted: $• . . . . j00.. 00 NI
GARY F� NFR, OLSEN, ESQ,
CUTCHOOUE, U., s�:Y.. jig �. . . . . . . . . . .
Q� �a ' . . • .APPLICANT
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CONSENT
TO
INSPECTION
Antone J. Wysocki Jr. and Rosemary T. Wysocki the undersigned,,
Owners) Name(s)
do(es) hereby state:
T hat the undersigned (is) (are) the owner(s) of the premises in the Town
1 Main Road, Cutchogue
of Southold located at
which is shown and designated on the Suffolk
as District 1000, Sectionp97%-00 Blocic 0�. Lot 004.000
ma
County tax p
d to be filed, an applica-
That the undersigned (has) (have) filed, 'or cause
tion in-the Southold Town Yuliaing lnsp` t;L-j- 'J Far +h,* fnllowina:
inn 1/2 story frame house and detached garage
That the undersigned doles) hereby give consent to the I3uilding Inspectors
of the Town of Southold to enter upon the above described property, including
an and all buildings located thereon, to conduct such inspections as they may
Y
cation, includinginspections
dee
m necessary with respect to the aforesaid appli
to dete
r that said premises comply with all of the laws, ordinances, rules
and regulations of the Town of Southold.
in consenting to such inspections, do(es) so with the
The undersigned,
obtained I
led a and understanding that any information n the conduct of
knowledge
ins ections may be used as evidence in subsequent prosecutions for vio-
such p
outhold.
of the laws, ordinances, rules or regulations of the Town of S
lations
� r
Dated: March 2, 1995 (signatur
rint nam )
(signature)
MAR - 3 1995
(print name)
TO 1117,1 Or