HomeMy WebLinkAboutZ-14277 FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z.1.4�77. . . . . . . . . . Date . . . March. .1.3 . . . . . . . . . . . . . . . . . . .. 1986.
THIS CERTIFIES that the building3. . . .0 n m 7.ly. . d W.e.7.17 n g.. . . . ... . . . . . . . . . . . . . . .
Location of Property 1 1 9.1 5 ,M A I N R O A D R T . 25 EAST M A R I O N
House No. Street * * . * * * A;rmJet
County Tax Map No. 1000 Section . .31 . . . . . . . .Block . . . . . 5. . . . . . . . .Lot . . . 1 , 1. . . . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . .Lot No. . . . . . . . . . . . . .
Requirements for a private one-family dwelling built prior to
conforms substantially to thep34XiXiib]fdleXf ) dX�I �eXcXa}f
April 23 57 CERTIFICATE OF OCCUPANCY
. . . . . . . . . . . . . . . 19 . pursuant to which7EUdihX P9rkKf[N8X . . . . . . .#Z.1.4 2 7.7. . . . . .
dated .M a r-c.h . 13. . . . . . . . . . . . . . . . . . 19 8 6 ,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. .f.amil.y. .dwe.Llzng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The certificate is issued to . . . . . S.T A N L E Y J . M A L I N A U S K A S
(o wner,� d{�Iryt��ftl . . . . . . . . . . . . . . . . . . . . .
of the aforesaid building.
Suffolk County Department of Health Approval N/A Pre e x i s t i n g
UNDERWRITERS CERTIFICATE NO. . . . . . . . . .N/A. Pre e x i s t i n g
** Please see attached inspection report .
Building Inspector
Rev.1/81
FORM NO.6 PP
IL
TOWN OF SOUTHOLD �, F DEC 2 0 I985 ;
Building Department
Town Halle_.._._®_
Southold, N.Y. 11971 LDG. DEPT.
TOWN OF SOUTHOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted4n=dup4eet&to the Building Inspec-
tor with the following;for new buildings 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 of Health Dept. of water supply and sewerage disposal—(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings,.Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling land use -Fre-Existing C . 0. $15 . 00
3. Copy of certificate of occupancy $1.00 II Vacant 'land C . O . $ 5 . 00
Date ,December . . . . . . . . . . . . . . .
New Building . . . . . . . .
. . . gld or Pre-existing Building . . . . . . . . . . . Vacant Land . . . . . . . . . . . . .G19�1S
Location of Property . Main Road East, Marion .. . . . . . ..
House No. Street Hamlet
Owner or Owners of Property . .' StanleX J.. .DZalinauskas
County Tax Map No. 1000 Section . . 31. . . . . . . . . . . Block . . . . . . . . . . . . . . Lot . . . . . l.t ). . . . . . .
Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . .
Permit No. . . . . . . . . . . Date of Permit . . . . . . . . . .Applicant . . . . . . . . . . . . . . . . .
Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .
Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . . . . . . . . . . . . . . .
Request for Temporary Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . . X . . . . . . . . . . . . . . .
Fee Submitted $ 15. 00. . . . . . . . . . . . . . . . . . . . . . .
Construction on above described building and permit meets all applicable codes and regulations.
Applicant-� * • �.1: . . . . . . . . . . . . . . . . .
. . . .
'S a e J Malinauskas
Rev.10-10-78
31g
�',�� c°. o z /4(-� ?7
CONSENT
TO
INSPECTION
STANLEY J. MALINAUSKAS the undersigned,
Owner • Name(s)
does; hereby state: r
That the undersigned _ is the owner.._; of the premises in the Town
of Southold located at 108-65 Main Road, East Marion, -New-York
. which :s shows and designated on the Suffolk
County tax map as District 1000, Section 31' Block 5 Lot 1'
That the undersigned' has filed, or causgd to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
Certificate of Pre-existing Use
That the undersigned does, 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 applications ineluding inspectionts
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, does 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: December
• � ature)
Stanley J. Malinauskas
` (pr:Pt,namg)
signature
(print name)
A' , DEC 2 01 i14
J U i .
3LDG. DEPT.
_ m T0WN OF SO�JTfiOLD
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT c
Location /
number & street Iflunicipality
Subdivision Map No. Lot(s)
Name of Owner(s)
Occupancy
type / ,own er_t P_n a n+
Admitted by: Accompanied by:
Keyavailable j"_ B
` Suffolk Co. Tax No. ,�,� /, 0
Source of request ate 1
DWELLING
Type of construction #stories
Foundation Cellar Crawl space
Total rooms, 1st. F1 S 2nd. Fl 3rd. F1
Bathroom(s) Toilet room(s)
Porch, type Deck, type Patio, type
Breezeway Garage Utility room
Type Heat Warm Air u -
Fireplace(s) No. Exits Airconditioning
Domestic hotwater "/4 Type heater
Other -_-G% `�—'
ACCESSORY STRUCTURES:
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other f- -
VIOLATIONS: Housing Code, Chapter 45� N.Y. State Uniform Fire Prevention
B ildi Code
Location Description Art. 1 Sec.
r.
f
1
C '
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Remarks: at
Inspected by: Date of Insp.
Time start 3,/ end
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