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Home My WebLink AboutZ-15129 FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. .Z 15.1.29. . . . . . . . . Date . December. 24. . . . . . . . . . . . . . . . . .. 106. THIS CERTIFIES that the building , ,0 n e. ,f a m i 1 y ,d w e.l 1 i n g .. . . . . . . . . . . . . . . . . . . . Location of Property 15505 MAIN ROAD , . . . . :. . . . ,MATTITUCK House IVo. Street *Ham%! County Tax Map No. 1000 Section . 1.14. . . . . . . .Block . . 6. . . . . . . . . . .Lot . . . , 04 Subdivision . . EE. .EE. .TT. . . . .o. . . . . . ... . . . . . . . . . .E.F"illed Map No. . . . . .. . . .Lot No. . . . . . . . . . . . . . conforRltEi4 sulbstantially to thRe i�jzl fivia = uw V41C ez=k Fie f aci &vff=eRIOR T� - CERTIFICATE OF OCCUPANCY: Z15129 Ap r i 1 . . 2.3 . . . . . . , 19 5?. pursuant to which MMUNM499XXXXXXX, dated . . .D E C E M B E R. 24 . . . . , , , , 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 . . . . . . . . . QAe ,fpRi.1y, dwelling . , and . smal1 . wood, st.ora e, .building... . . . . . . . . . . . . The certificate is issued to . , S U S AN. R O A C H E. . . . . , , . . . . . . . • . �(ownei%Fslk�edid+�d of the aforesaid building. Suffolk County Department of Health Approval . . . . . . . . .. N./.A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . 14.44 . . . . . . . . . . . . . . . . . . . . . . . . . . .. . SEE ATTACHED INSPECTION REPORT . . . . . . . . . . . Building Inspector Rev.1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD, N. Y. ° HOUSING CODE INSPECTION REPORT Location - 15505 MAIN ROAD MAT TITUCK number & street Municipality Subdivision Plap No. Lots) Name of Owner(s) SUSAN ROACHE Occupancy R- 1 OWNER type owner-tenant Admitted by: SUSAN ROACHE Accompanied by: SAME Keyavailable � Suffolk Co. Tax No. 114-06-04 Source of request SUSAN ROACHE Date 12/21 /86 DWELLING: Type of construction WOOD FRAMED #stories 2 Foundation BRICK Cellar PARTIAL Crawl space REST Total rooms, lst. Fl 4 2nd. F1 4 3rd. F1 Bathroom(s) 1 Toilet room(s) Porch, type Deck, type Patio, type Breezeway Garage Utility room Type Heat eas Yarm Air Hotwater xx Fireplace(s) No. Exits 4 Airconditioning Domestic ho twat er jgs Type heater_ gas Other ACCESSORY STRUCTURES: Garage, type const. . Storage, type const. ,.od-small Swimming pool Guest, type const. Other VIOLATIONS: Housing Code, Chapter 45' N.Y. State Uniform Fire Prevention Buildina Code Location Description lArt. Sec. DWELLING HAS THREE SMOKE DETECTORS I - Remarks: NO VIOLATION WERE FOUND., Inspected by:� �,�lii `�Date of Insp. 12/2 1 /86 CURTIS W . HORTON' "�`�Time start jjjj end in, nn !/v�u FORM NO.6 TOWN OF SOUTHOLD !1�, '' r 1986 Building Department Town Hall Southold, N.Y. 11971 765 — 1802 -- APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted 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. For existing buildings (prior.to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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 $15. 0 0 3. Copy of certificate of occupancy $1.00 4 .Vacant Land C.O. $5. 00 ! . 5.Updated C.O. $15.00 Date . . . .� z. . . �v � . . . . . . New Construction , , , , , . Old or Pre-existing Building . . . . . . . . . Vacant Land . . . . . . . . . . . . . Location of Property,1.�`'. =?.Q4`?. . . . . . ./.V �y1� House No. Street Hamlet. Owner or Owners of Property . . . V �� /.i/. . . . . �,d./.�.� /;`'� . . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section . . . . . . . Block .0 . . . . . Lot . . . .d. .T. . . ... . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. . . . . . . . . . . . . . . PermitNo. . . . . . . . . . . Date of Permit . . . . . . . .Applicant . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . .Labor Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . . Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval . . . . . . . . . . . . . . . . . . . . . . Request for Temporar Certificate . . . . . . . . . . . . . . . . . . . . .Final Certificate . . . . . . . . . . . . . . . . . . . . . . . Fee Submitted $ Construction on above described buildi n it meets all applicabl tles and re ulations. Applican .� . . . . . . . . . Rev.10-10-78 4 3 Q G CONSENT TO INSPECTION the undersigned, Owner(s) Names do(es) hereby state: That the undersigned (is) f -the owner(3r) of the premises in the Town of Southold located at 16, which is shown and designated on the Suffolk County tax map as District 1000, Section , Block , Lot , That the undersigned (has) ( filed, 'or caused to be filed, an applica- ti he Southold Town Building Inspector's Office for the following: " - C D - 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 may be used as evidence in subsequent prosecutions for vio- lations of the laws, 7or;dinanc s, rules or regulations of the Town of uthold. Dated: A (sig 7p, (print na e) (signature) (print name)