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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-24392 Date MAY 31, 1996
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 3075 WEST CREEK AVE. CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 110 Block 5 Lot S
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-24392 dated MAY 31, 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 DWELLING *
The certificate is issued to HERBERT YOUNG
(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.
aw,
Building I pector
Rev. 1/81
BU 1 L.D LNG DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 3075 WEST CREEK AVE. CUTCHOGUE, N.Y.
number S street)— (municipality)
SUBDIVISION MAI) NO. I.OT(s)
NAME OF OWNER (s) HERBERT YOUNG
OCCUPANCY SEASONAL
type owner—tenant)
ADMITTED BY: HERBERT YOUNG ACCOMPANIED BY: SAME _
KEY AVAILABLE SUFF.CO. TAX MAP NO. 1000-110=5-8
SOURCE OF REQUEST: DEBORAH DOTY, ATTY DATE: MAY 202 1996
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES 1 Y EXITS 3
FOUNDATION CEMENT BLOCK & PIERS CELLAR PART CRAWL SPACE
TOTAL ROOMS: 1ST FI.R. 5 2ND FLR. 3RD FLR.
BATHROOM (s) ONE TOILET ROOM (s) UTILITY ROOM
PORCH TYPE FRONT SCREENED COVERED _ DECK, TYPE PATIO CEMENT BLOCK
BREEZEWAY FIREPLACE ONE GARAGE
DOMESTIC HOTWATER XX TYPE HEATER LILCO AIRCONDITIONING
TYPE HEAD' NONE WARM AIR _ ❑OTWATER Y ;:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. 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.
REMARKS:
INSPECTED BY- t2k 71, DATE OF INSPECTION MAY 24, 1996
J HN M. BOUFIS TIME START 9:45 END 10:05
' Orin No. 6
TOWN OF SOUT11OLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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-
I . 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-dispos2l(S-9 form) .
3. Approval of electrical installation from Board of Fire Underwriters.
�. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1.7. 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 Buildine - $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
5/20/96
Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . Yes
Location of Property. . . . 3075.West.Creek.Avenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . .GutQhOgue. . . . . . .
House No. Street hamlet
Herbert A. Young
Onwer or Owners of Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
�ounty Tax Map No 1000, Scction . .110. . . . . . . . . B.1ocic. . . . . . . . . . . . . . . .Lot. . . . 8. . . . . . . . . . . . . . . .
.Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Failed Hop . . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . .
"ermit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .App.lic.111t. . . . . . . ... . . . . . . . . . . . . I . . . . . . .
Health Debt. Approval . . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . . .
'lanning Board Al)prov;il. . . . . . . . . . . . . . . . . . . . . . . .
request for: Temporary Certificate. . . . . . . . . . . Fiiial Certicate. . . . . . . . . . .
100
lee Submitted - $ . . . . .. . . . I . . . . . . . . . . . . . . . . . . . .
00
C �cS�3�
,. . . . . . . . . .
CONSENT.
TO
I IN,SPEC'i'toN
Herbert A. Younq the undersigned,
Oxnier(s) Name(s) .
do(es) herebv state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
Of Southold located at 3075 West Creek Avenue, Cutchouge
'Which is shown and designated on the Suffoli:
County tax map as District 1000, Section 110 Block 5 Lot 8
That the undersigned (has) ((lave) filed, or caused to be filed, all applica-
tion in the Southold Town Building Inspector's Office for the following:
Pre-Existing Certifica P of nrc-t ant
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 inay be used as evidence in subsequent prosecutions for vio-
lations, of the laws, ordinances, rules or regulations of the 'Town of Southold.
Dated.- 5/20/96
(signature)
CONTACT: � �- - , Deborah Doty, as' atty for owner
Y�cuna 73 2�
• (print name)
(signature)
(print nanie)
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SUR VEY OF
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ok`` 3� ��c6 \ PROPERTY
AT FLEET'S NECK
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�• �`8 TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY
�• �/ �_ 9 2 1000 — 110 — 05 — 08
Scale: 1"= 30"
May 15, 1996
n
G
01�
o� 5• CERTIFIED TO,
CHRIS KUEHN
o , \ S,�A�E OF F
,0
A O ANY ALTERAT%ON OR ADDITION TO FMS'SURVEY IS A VIOLATION r ''
O r OF SECTION 7209 OF THE NEW YORK STATE EDUCA TION LAW, s G�
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS L1C. NO. 4961-8
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP.OR. COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
' WHOSE S/GNA TORE APPEARS HEREON. PECONIC S
C (516) 765 - 5020
V ADDITIONALLY TO COMPLY WITH SAID LAW.THE TERM 'ALTERED BY" P. O, BOX 909
MUST BE USED BY ANY AND ALL .SURVEYORS UTILIZING A COPY /230 TRA VELER STREET
AREA = 20,000 SCE!f f OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS INSPECTED'AND SOUTHOLDp N.Y. 11971
'BROUGHT-TO-DATE'ARE NOT IN COMPLIANCE WITH THE LAW.
96 — 172